Provider Demographics
NPI:1821554080
Name:DREISER MALL PHARMACY LLC
Entity Type:Organization
Organization Name:DREISER MALL PHARMACY LLC
Other - Org Name:GREEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAR
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:NADEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-998-1993
Mailing Address - Street 1:133 DREISER LOOP
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2704
Mailing Address - Country:US
Mailing Address - Phone:347-899-8199
Mailing Address - Fax:347-899-8199
Practice Address - Street 1:133 DREISER LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2704
Practice Address - Country:US
Practice Address - Phone:347-899-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy