Provider Demographics
NPI:1245514942
Name:DRUGSTORE PHARMACY, LLC
Entity type:Organization
Organization Name:DRUGSTORE PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-288-0007
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07511-0537
Mailing Address - Country:US
Mailing Address - Phone:240-498-2151
Mailing Address - Fax:718-783-0893
Practice Address - Street 1:209 WISE AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4911
Practice Address - Country:US
Practice Address - Phone:410-288-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD048239100Medicaid
MDW14266498OtherDEPARTMENT OF TAXATION ID