Provider Demographics
NPI:1841398872
Name:KEW GARDENS DRUG CORP
Entity Type:Organization
Organization Name:KEW GARDENS DRUG CORP
Other - Org Name:JAMRON DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAROOQ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-849-6700
Mailing Address - Street 1:11807 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11807 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2020
Practice Address - Country:US
Practice Address - Phone:718-849-6700
Practice Address - Fax:718-849-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019239332B00000X
333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3388508OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY01295129Medicaid