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Organization
CIVA DRUG CORP
Active
Organization
CIVA DRUG CORP
Active
Parent organization
CIVA DRUG CORP
Other names
Brentwood Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
CIVA DRUG CORP
Authorized official
DIGESH C THAKER (SUPERVISING PHARMACIST)
(631) 273-3314
Entity
Organization
Contact information
Practice address
761 SUFFOLK AVE, BRENTWOOD, NY 11717-4409
(631) 273-3314
(631) 273-8863
Mailing address
761 SUFFOLK AVE, BRENTWOOD, NY 11717-4409
(631) 273-3314
(631) 273-8863
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00713240
—
NY
Enumeration date
04/25/2023
Last updated
04/25/2023
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