Provider Demographics
NPI:1386907137
Name:DEER PARK SUPER DRUGS INC
Entity type:Organization
Organization Name:DEER PARK SUPER DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-940-9472
Mailing Address - Street 1:1155 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3105
Mailing Address - Country:US
Mailing Address - Phone:631-940-9472
Mailing Address - Fax:631-940-9477
Practice Address - Street 1:1155 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3105
Practice Address - Country:US
Practice Address - Phone:631-940-9472
Practice Address - Fax:631-940-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0309813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5805429OtherNCPDP PROVIDER IDENTIFICATION NUMBER