# CIVA DRUG CORP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CIVA DRUG CORP
- **Other names:** Brentwood Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336837780
- **Legal business name:** CIVA DRUG CORP
- **Authorized official:** DIGESH C THAKER (SUPERVISING PHARMACIST)
- **Authorized official phone:** (631) 273-3314

## Contact information

- **Practice address:** 761 SUFFOLK AVE, BRENTWOOD, NY 11717-4409
- **Practice address phone:** (631) 273-3314
- **Practice address fax:** (631) 273-8863
- **Mailing address:** 761 SUFFOLK AVE, BRENTWOOD, NY 11717-4409
- **Mailing address phone:** (631) 273-3314
- **Mailing address fax:** (631) 273-8863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/25/2023
- **Last updated:** 04/25/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00713240 | — | NY |