Provider Demographics
NPI:1740345347
Name:DRUG DEPOT INC
Entity type:Organization
Organization Name:DRUG DEPOT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EJTEMAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-652-0600
Mailing Address - Street 1:7025 BROOKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3263
Mailing Address - Country:US
Mailing Address - Phone:301-652-0600
Mailing Address - Fax:
Practice Address - Street 1:7025 BROOKVILLE RD
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3263
Practice Address - Country:US
Practice Address - Phone:301-652-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP009233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5947960001Medicare NSC