Provider Demographics
NPI:1952640088
Name:WAKEFIELD DRUGS INC
Entity Type:Organization
Organization Name:WAKEFIELD DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SP PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GOGI
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-341-5756
Mailing Address - Street 1:4334A WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3098
Mailing Address - Country:US
Mailing Address - Phone:718-547-0040
Mailing Address - Fax:718-547-0046
Practice Address - Street 1:4334A WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3098
Practice Address - Country:US
Practice Address - Phone:718-547-0040
Practice Address - Fax:718-547-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031633333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031633OtherSTATE BOARD OF PHARMACY, NEW YORK
NY7223760001Medicare NSC