Provider Demographics
NPI:1295885010
Name:THE DRUG SHOPPE, INC
Entity type:Organization
Organization Name:THE DRUG SHOPPE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-362-0460
Mailing Address - Street 1:416 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2860
Mailing Address - Country:US
Mailing Address - Phone:716-362-0460
Mailing Address - Fax:716-362-0461
Practice Address - Street 1:416 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2860
Practice Address - Country:US
Practice Address - Phone:716-362-0460
Practice Address - Fax:716-362-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027313333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684040Medicaid
3346144OtherNABP
3346144OtherNABP
NY02684040Medicaid