Provider Demographics
NPI:1871823559
Name:NYC DRUG STORE, INC.
Entity Type:Organization
Organization Name:NYC DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-380-0999
Mailing Address - Street 1:15916 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1938
Mailing Address - Country:US
Mailing Address - Phone:718-380-0999
Mailing Address - Fax:718-969-4999
Practice Address - Street 1:15916 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1938
Practice Address - Country:US
Practice Address - Phone:718-380-0999
Practice Address - Fax:718-969-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297883336C0003X, 3336C0004X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6412650001Medicare NSC