MEDICARE: MCDERMOTT DRUG CORP

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	28RS00627000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2058221	OTHER		PK

General Provider Information

NPI Number	:	1558303339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCDERMOTT DRUG CORP

Provider Business Mailing Address
First Line	:	433 UNION AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07502-1917
Country	:	US
Telephone Number	:	973-790-8486
Fax Number	:	973-790-3315

Provider Business Practice Location Address
First Line	:	433 UNION AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07502-1917
Country	:	US
Telephone Number	:	973-790-8486
Fax Number	:	973-790-3315

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMIT DATWANI
Credential	:
Telephone Number	:	973-790-8486

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/19/2024

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Directions to “MCDERMOTT DRUG CORP ” Practice Location

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