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General NPI Number Information
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NPI Number | 1659369783
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Entity Type | Organization
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Legal Business Name | 5TH AVE DRUG, INC
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1805 5TH AVE SUITE B
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City | BAY SHORE
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State | NY
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Zip | 11706-1761
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Country | US
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Telephone | 631-231-4960
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Fax | 631-231-0368
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Provider Business Mailing Address
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Address Line | 1805 B FIFTH AVE.
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City | BAY SHORE
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State | NY
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Zip | 11706
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Country | US
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Telephone | 631-231-4960
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Fax | 631-231-0368
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TOMAS DIAZ
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Credential | RPH
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Telephone | 631-231-4960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 020130
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | NY
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