Provider Demographics
NPI:1366526584
Name:272 DRUG CORP
Entity type:Organization
Organization Name:272 DRUG CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YACOOB
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-773-5547
Mailing Address - Street 1:4623 CHURCH AV
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-773-5547
Mailing Address - Fax:718-773-5568
Practice Address - Street 1:4623 CHURCH AV
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-773-4457
Practice Address - Fax:718-773-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017632OtherPHARMACY REGISTRATION NUM
NY3376147OtherNABP NUMBER
NYB9 5265461OtherDEA NUMBER
NY5124120001Medicare ID - Type UnspecifiedMEDICARE NUMBER
NY5124120001Medicare ID - Type UnspecifiedMEDICARE NUMBER