Healthcare Provider Details

I. General information

NPI: 1750466967
Provider Name (Legal Business Name): 133 DRUG CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LAKEVIEW AVE
LYNBROOK NY
11563-1742
US

IV. Provider business mailing address

133 LAKEVIEW AVE
LYNBROOK NY
11563-1742
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-4646
  • Fax: 516-599-6383
Mailing address:
  • Phone: 516-599-4646
  • Fax: 516-599-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number039982
License Number StateNY

VIII. Authorized Official

Name: MR. ANTHONY V FAZIO
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 516-599-4646