Healthcare Provider Details

I. General information

NPI: 1174736292
Provider Name (Legal Business Name): DUANE READE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 9TH AVENUE 6TH FLOOR
NEW YORK NY
10001-1620
US

IV. Provider business mailing address

1901 E VOORHEES ST MS 790
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-5700
  • Fax: 212-244-6499
Mailing address:
  • Phone: 217-709-2386
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KERMIT R CRAWFORD
Title or Position: PRESIDENT
Credential:
Phone: 847-315-3193