Provider Demographics
NPI:1942392121
Name:D.C.R.C. CORP
Entity Type:Organization
Organization Name:D.C.R.C. CORP
Other - Org Name:CONTINENTAL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-854-3535
Mailing Address - Street 1:6419 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4109
Mailing Address - Country:US
Mailing Address - Phone:201-854-3535
Mailing Address - Fax:201-854-6770
Practice Address - Street 1:6419 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-4109
Practice Address - Country:US
Practice Address - Phone:201-854-3535
Practice Address - Fax:201-854-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS0054700333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4472670001Medicare NSC