Healthcare Provider Details

I. General information

NPI: 1558357541
Provider Name (Legal Business Name): DBG SECURITY DRUGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 BOSTON RD
BRONX NY
10469-2501
US

IV. Provider business mailing address

3419 BOSTON RD
BRONX NY
10469-2501
US

V. Phone/Fax

Practice location:
  • Phone: 718-654-6974
  • Fax: 718-882-4648
Mailing address:
  • Phone: 718-654-6974
  • Fax: 718-882-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024415
License Number StateNY

VIII. Authorized Official

Name: MR. NATWAR G GEVARIA
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 718-654-6974