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General NPI Number Information
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NPI Number | 1770991226
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Entity Type | Organization
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Legal Business Name | MOURAD DRUG CORP
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 312 MAIN STREET
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City | MIDDLEBURGH
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State | NY
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Zip | 12122
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Country | US
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Telephone | 518-702-4176
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 978
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City | MIDDLEBURGH
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State | NY
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Zip | 12122-0978
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Country | US
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Telephone | 518-702-4176
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | AKRUM MOURAD
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Credential | RPH
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Telephone | 212-991-8857
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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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