Provider Demographics
NPI:1396916961
Name:NEKOS RED HOOK DRUG STORE INC
Entity type:Organization
Organization Name:NEKOS RED HOOK DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NEKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-758-5057
Mailing Address - Street 1:7501 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1437
Mailing Address - Country:US
Mailing Address - Phone:845-758-5057
Mailing Address - Fax:845-758-3761
Practice Address - Street 1:7501 N BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1437
Practice Address - Country:US
Practice Address - Phone:845-758-5057
Practice Address - Fax:845-758-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154227Medicaid
NY4174080001Medicare NSC