Provider Demographics
NPI:1770948515
Name:WOODHAVEN DRUGS INC
Entity type:Organization
Organization Name:WOODHAVEN DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALACHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-478-4600
Mailing Address - Street 1:6204B WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2745
Mailing Address - Country:US
Mailing Address - Phone:718-478-4600
Mailing Address - Fax:718-478-7731
Practice Address - Street 1:6204B WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2745
Practice Address - Country:US
Practice Address - Phone:718-478-4600
Practice Address - Fax:718-478-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X
NY0342913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157613OtherPK