Provider Demographics
NPI:1891784195
Name:ALL AMERICAN DRUGGIST INC
Entity Type:Organization
Organization Name:ALL AMERICAN DRUGGIST INC
Other - Org Name:ALL AMERICAN DRUGGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUP PHARM
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-891-2801
Mailing Address - Street 1:1101 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5558
Mailing Address - Country:US
Mailing Address - Phone:718-891-2801
Mailing Address - Fax:718-743-5804
Practice Address - Street 1:1101 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5558
Practice Address - Country:US
Practice Address - Phone:718-891-2801
Practice Address - Fax:718-743-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0187623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00910045Medicaid
2063587OtherPK
NY00910045Medicaid