Provider Demographics
NPI:1881928224
Name:BROADWAY DRUGS INC
Entity type:Organization
Organization Name:BROADWAY DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-312-7550
Mailing Address - Street 1:3408 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1112
Mailing Address - Country:US
Mailing Address - Phone:718-728-0350
Mailing Address - Fax:718-728-0384
Practice Address - Street 1:3408 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1112
Practice Address - Country:US
Practice Address - Phone:718-728-0350
Practice Address - Fax:718-728-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0296963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122247OtherPK
NY3333846Medicaid