Provider Demographics
NPI:1023328085
Name:SEVENTH ELM DRUG CORP
Entity type:Organization
Organization Name:SEVENTH ELM DRUG CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANOV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-255-6100
Mailing Address - Street 1:56 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6672
Mailing Address - Country:US
Mailing Address - Phone:212-255-6100
Mailing Address - Fax:212-255-6112
Practice Address - Street 1:56 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6672
Practice Address - Country:US
Practice Address - Phone:212-255-6100
Practice Address - Fax:212-255-6112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEVENTH ELM DRUG CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RO001441003336C0003X
NY030275333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127205OtherPK
NY03283387Medicaid
NY03283387Medicaid