=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922172337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIN DRUGS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 05/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1077 BRIGHTON BEACH AVENUE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-769-2043
-----------------------------------------------------
Fax | 718-743-4645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1077 BRIGHTON BEACH AVENUE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-769-2043
-----------------------------------------------------
Fax | 718-743-4645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SP PHARMACIST
-----------------------------------------------------
Name | MR. ALAN BLUESTER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 718-769-2043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 17368
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------