Provider Demographics
NPI:1881687069
Name:SHRI DRUG INC
Entity Type:Organization
Organization Name:SHRI DRUG INC
Other - Org Name:SURE DRUGS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTAMWAR
Authorized Official - Suffix:I
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-774-6800
Mailing Address - Street 1:26 IRVING DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1333
Mailing Address - Country:US
Mailing Address - Phone:718-774-6800
Mailing Address - Fax:718-774-1776
Practice Address - Street 1:312 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3022
Practice Address - Country:US
Practice Address - Phone:718-774-6800
Practice Address - Fax:718-774-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016289333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3366449OtherNCPDP
NY00316927Medicaid
NY00316927Medicaid