Provider Demographics
NPI:1780970269
Name:DUANE READE
Entity type:Organization
Organization Name:DUANE READE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-356-5227
Mailing Address - Street 1:PO BOX 2253
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10116-2253
Mailing Address - Country:US
Mailing Address - Phone:212-356-5227
Mailing Address - Fax:212-244-6499
Practice Address - Street 1:405 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10174-0002
Practice Address - Country:US
Practice Address - Phone:212-808-4743
Practice Address - Fax:212-808-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI033372003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3334187OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY01543686Medicaid
3334187OtherOTHER ID NUMBER-COMMERCIAL NUMBER