Provider Demographics
NPI:1992868517
Name:ASZ DRUG CORP
Entity Type:Organization
Organization Name:ASZ DRUG CORP
Other - Org Name:ASZ DRUG CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANG
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EDREIS
Authorized Official - Suffix:
Authorized Official - Credentials:SP PHARM
Authorized Official - Phone:718-996-9299
Mailing Address - Street 1:121 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3605
Practice Address - Country:US
Practice Address - Phone:718-996-9299
Practice Address - Fax:718-996-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0241473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01911182Medicaid
3302546OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY01911182Medicaid