MEDICARE: EXPRESS DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	025578	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4858750001	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3329946	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1750362992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS DRUG STORE INC

Provider Business Mailing Address
First Line	:	1408 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3702
Country	:	US
Telephone Number	:	718-677-5800
Fax Number	:	718-677-0708

Provider Business Practice Location Address
First Line	:	1408 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3702
Country	:	US
Telephone Number	:	718-677-5800
Fax Number	:	718-677-0708

Authorized Official
Title or Position	:	VP
Name	:	DMITRIY PERELMAN
Credential	:	PHARMD
Telephone Number	:	718-677-5800

Provider Enumeration Date	:	11/06/2005
Last Update Date	:	12/15/2010

Similar Medicare Providers

1609857515 — DMITRIY R PERELMAN PHARMD
Practice Location Address:

1420 AVENUE J
BROOKLYN, NY
11230-3702

Practice Phone: 718-677-5800
Practice Fax:

1659623791 — CUSTOM CHEMISTS INC.
Practice Location Address:

1408 AVENUE J
BROOKLYN, NY
11230-3702

Practice Phone: 718-677-8500
Practice Fax: 718-677-8501

1548127632 — CUSTOM CHEMISTS INC.
Practice Location Address:

1408 AVENUE J
BROOKLYN, NY
11230-3702

Practice Phone: 718-677-8500
Practice Fax: 718-677-8501

1912988197 — DR. LYNN GARGANO DDS
Practice Location Address:

5800 3RD AVE , SCHOOL HEALTH DENTAL
BROOKLYN, NY
11220-3702

Practice Phone: 718-630-8526
Practice Fax: 718-630-8714

1376520122 — KISHA NICOLA MCCAIN C.R.N.A.
Practice Location Address:

451 CLARKSON AVE
BROOKLYN, NY
11203-3702

Practice Phone: 718-245-4408
Practice Fax:

1932187333 — FERN A GRUBER DDS
Practice Location Address:

3702 QUENTIN RD
BROOKLYN, NY
11234-4206

Practice Phone: 718-339-3161
Practice Fax:

Directions to “EXPRESS DRUG STORE INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.