Healthcare Provider Details

I. General information

NPI: 1821531898
Provider Name (Legal Business Name): SINA DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 MARCUS AVE STE 120
NEW HYDE PARK NY
11042-2024
US

IV. Provider business mailing address

13410 EASTPOINT CENTRE DR STE 101
LOUISVILLE KY
40223-4160
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax: 877-662-6355
Mailing address:
  • Phone: 877-662-6633
  • Fax: 877-662-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number25289
License Number StateNY

VIII. Authorized Official

Name: RANDOLPH FALKENRATH
Title or Position: PRESIDENT
Credential:
Phone: 877-662-6633