=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336150507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGO DRUG CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5512 MYRTLE AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-3551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-821-5225
-----------------------------------------------------
Fax | 718-821-3055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5512 MYRTLE AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-3551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PHARMACIST
-----------------------------------------------------
Name | MICHAEL LEVENBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-821-5225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 011293
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------