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
—
—
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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