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General NPI Number Information
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NPI Number | 1962543215
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Entity Type | Organization
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Legal Business Name | DRUG STORE INCORPORATED
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2204 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6624
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Country | US
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Telephone | 718-982-9438
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Fax | 718-698-8978
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Provider Business Mailing Address
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Address Line | 2204 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6624
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Country | US
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Telephone | 718-982-9438
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Fax | 718-698-8978
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Authorized Official
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Title or Position | PHARMACIST CO OWNER
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Name | MR. NICHOLAS AVICOLLI
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Credential | R.PH
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Telephone | 718-982-9438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 024721
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License Number State | NY
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