Provider Demographics
NPI:1932106366
Name:THRIFTWAY FOSTER AVE. DRUG CORP
Entity Type:Organization
Organization Name:THRIFTWAY FOSTER AVE. DRUG CORP
Other - Org Name:THRIFTWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP. SECY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PERCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-835-2000
Mailing Address - Street 1:1717 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1809
Mailing Address - Country:US
Mailing Address - Phone:718-724-1717
Mailing Address - Fax:718-859-4688
Practice Address - Street 1:1717 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1809
Practice Address - Country:US
Practice Address - Phone:718-724-1717
Practice Address - Fax:718-859-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027122333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02640233Medicaid
NY5359890001Medicare ID - Type Unspecified