Healthcare Provider Details

I. General information

NPI: 1104011915
Provider Name (Legal Business Name): ESQUIRE DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROADWAY
MENANDS NY
12204-2797
US

IV. Provider business mailing address

100 BROADWAY
MENANDS NY
12204-2797
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-2291
  • Fax: 518-463-1537
Mailing address:
  • Phone: 518-463-2291
  • Fax: 518-463-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022773
License Number StateNY

VIII. Authorized Official

Name: MR. FRANK R RENNA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 518-463-2291