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General NPI Number Information
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NPI Number | 1669929170
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Entity Type | Organization
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Legal Business Name | STM DRUG CORP
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 3705 83RD ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7141
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Country | US
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Telephone | 718-803-3330
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Fax | 718-803-3320
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Provider Business Mailing Address
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Address Line | 3705 83RD ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7141
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Country | US
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Telephone | 718-803-3330
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Fax | 718-803-3320
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARMEN GENAO
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Credential |
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Telephone | 917-609-8155
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 034771
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License Number State | NY
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