Provider Demographics
NPI:1952944324
Name:DVB INC
Entity Type:Organization
Organization Name:DVB INC
Other - Org Name:MAIN STREET CHEMIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VENIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-641-0407
Mailing Address - Street 1:216 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1649
Mailing Address - Country:US
Mailing Address - Phone:914-494-3352
Mailing Address - Fax:
Practice Address - Street 1:216 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-1649
Practice Address - Country:US
Practice Address - Phone:201-641-0407
Practice Address - Fax:201-500-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0744085Medicaid