Provider Demographics
NPI:1649531963
Name:ECKERSON DRUGS INC
Entity type:Organization
Organization Name:ECKERSON DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:845-352-1800
Mailing Address - Street 1:275 N MAIN ST
Mailing Address - Street 2:UNIT 12/287
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2915
Mailing Address - Country:US
Mailing Address - Phone:845-352-1800
Mailing Address - Fax:845-352-8645
Practice Address - Street 1:287 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2914
Practice Address - Country:US
Practice Address - Phone:845-352-1800
Practice Address - Fax:845-352-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0313963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136510OtherPK
NY03468797Medicaid
6709540001Medicare NSC