Provider Demographics
NPI:1336916493
Name:DURGA MATA RX INC
Entity Type:Organization
Organization Name:DURGA MATA RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTINEEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-844-7099
Mailing Address - Street 1:350 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 NASSAU RD
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1350
Practice Address - Country:US
Practice Address - Phone:718-844-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy