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General NPI Number Information
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NPI Number | 1639211790
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Entity Type | Organization
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Legal Business Name | EVANS DRUG STORE,INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 878 NOSTRAND AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11225
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Country | US
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Telephone | 718-771-7271
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Fax | 718-953-5626
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Provider Business Mailing Address
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Address Line | 878 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-2226
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Country | US
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Telephone | 718-771-7271
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Fax | 718-953-5626
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ROBERTA GREENFELD
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Credential |
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Telephone | 718-771-7271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 023657
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License Number State | NY
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