Organization
CIVA DRUG CORP
Active
Other names
BRENTWOOD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DIGESH THAKER (RX MNGR)
(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
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
017492
NY
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00713240
—
NY
01
—
2061389
PK
—
Enumeration date
08/10/2006
Last updated
09/19/2025
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