MEDICARE: E T DRUGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	017642	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2061728	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376655381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E T DRUGS INC

Provider Business Mailing Address
First Line	:	173 BROAD ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2057
Country	:	US
Telephone Number	:	718-447-4127
Fax Number	:	718-273-1232

Provider Business Practice Location Address
First Line	:	173 BROAD ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2057
Country	:	US
Telephone Number	:	718-447-4127
Fax Number	:	718-273-1232

Authorized Official
Title or Position	:	PRES
Name	:	ETHAN ASEDO
Credential	:	BS
Telephone Number	:	718-442-4127

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/13/2016

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Directions to “E T DRUGS INC ” Practice Location

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