MEDICARE: DUANE READE

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	3336C0003X	Community/Retail Pharmacy	018614	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	018614	NY

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	3379977	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1629093125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUANE READE

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MS 790
City	:	DANVILLE
State	:	IL
Zip	:	61834-4515
Country	:	US
Telephone Number	:	217-709-2351
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 MYRTLE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5511
Country	:	US
Telephone Number	:	718-237-4526
Fax Number	:	718-237-0348

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER PONCE
Credential	:
Telephone Number	:	847-527-2489

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	10/01/2025

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Directions to “DUANE READE ” Practice Location

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