=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356357685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITYDRUG & SURGICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2039 AMSTERDAM AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-781-1011
-----------------------------------------------------
Fax | 212-781-3930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2039 AMSTERDAM AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-781-1011
-----------------------------------------------------
Fax | 212-781-3930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSE A CASERES
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 212-781-1011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 022649
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------