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General NPI Number Information
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NPI Number | 1942392121
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Entity Type | Organization
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Legal Business Name | D.C.R.C. CORP
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 6419 PARK AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-4109
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Country | US
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Telephone | 201-854-3535
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Fax | 201-854-6770
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Provider Business Mailing Address
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Address Line | 6419 PARK AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-4109
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Country | US
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Telephone | 201-854-3535
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Fax | 201-854-6770
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DOUGLAS CABALLERO
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Credential | R.PH
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Telephone | 201-854-3535
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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 | 28RS0054700
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License Number State | NJ
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