Healthcare Provider Details

I. General information

NPI: 1174534739
Provider Name (Legal Business Name): CIVA DRUG CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/19/2025
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 SUFFOLK AVE
BRENTWOOD NY
11717-4409
US

IV. Provider business mailing address

761 SUFFOLK AVE
BRENTWOOD NY
11717-4409
US

V. Phone/Fax

Practice location:
  • Phone: 631-273-3314
  • Fax: 631-273-8863
Mailing address:
  • Phone: 631-273-3314
  • Fax: 631-273-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number017492
License Number StateNY

VIII. Authorized Official

Name: DIGESH THAKER
Title or Position: RX MNGR
Credential:
Phone: 631-273-3314