Provider Demographics
NPI:1255415030
Name:DITMAS PHARMACY CORP
Entity type:Organization
Organization Name:DITMAS PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YARMOLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-675-0055
Mailing Address - Street 1:509 DITMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5001
Mailing Address - Country:US
Mailing Address - Phone:718-675-0055
Mailing Address - Fax:718-675-1274
Practice Address - Street 1:509 DITMAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5001
Practice Address - Country:US
Practice Address - Phone:718-675-0055
Practice Address - Fax:718-675-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY025147332BP3500X, 3336C0003X, 335E00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194118Medicaid
NY3323259OtherNABP #
NY02194118Medicaid