Provider Demographics
NPI:1841228210
Name:FULTON DRUGS INC
Entity Type:Organization
Organization Name:FULTON DRUGS INC
Other - Org Name:FULTON DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-986-6177
Mailing Address - Street 1:1548 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-5376
Mailing Address - Country:US
Mailing Address - Phone:718-735-3784
Mailing Address - Fax:718-735-6019
Practice Address - Street 1:1548 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5376
Practice Address - Country:US
Practice Address - Phone:718-735-3784
Practice Address - Fax:718-735-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0277983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068216OtherPK
NY02779459Medicaid
NY5727940001Medicare NSC
3351498OtherOTHER ID NUMBER