Provider Demographics
NPI:1821841305
Name:WAYNE DRUG CO INC
Entity Type:Organization
Organization Name:WAYNE DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-643-6300
Mailing Address - Street 1:24 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2051
Mailing Address - Country:US
Mailing Address - Phone:315-343-5722
Mailing Address - Fax:
Practice Address - Street 1:24 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2051
Practice Address - Country:US
Practice Address - Phone:315-343-5722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy