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General NPI Number Information
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NPI Number | 1750554820
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Entity Type | Organization
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Legal Business Name | THRIFTWAY 10TH AVE DRUG CORP
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 646 10TH AVE
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City | NEW YORK
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State | NY
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Zip | 10036-2929
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Country | US
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Telephone | 212-956-1100
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Fax | 212-956-1175
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Provider Business Mailing Address
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Address Line | 646 10TH AVE
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City | NEW YORK
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State | NY
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Zip | 10036-2929
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Country | US
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Telephone | 212-956-1100
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Fax | 212-956-1175
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Authorized Official
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Title or Position | CORP. SECY
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Name | MR. ALEX PERCHUK
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Credential | RPH
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Telephone | 718-835-2000
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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 | 028807
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License Number State | NY
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