Organization
EXPRESS DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DMITRIY PERELMAN PHARMD (VP)
(718) 677-5800
Entity
Organization
Contact information
Practice address
1408 AVENUE J, BROOKLYN, NY 11230-3702
(718) 677-5800
(718) 677-0708
Mailing address
1408 AVENUE J, BROOKLYN, NY 11230-3702
(718) 677-5800
(718) 677-0708
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
025578
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02374990
—
NY
01
—
3329946
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
4858750001
MEDICARE PTAN
—
Enumeration date
11/06/2005
Last updated
12/15/2010
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