Provider Demographics
NPI:1457340747
Name:NASCENT DRUG INC
Entity type:Organization
Organization Name:NASCENT DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEVON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH SP
Authorized Official - Phone:718-251-6444
Mailing Address - Street 1:5507 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1113
Mailing Address - Country:US
Mailing Address - Phone:718-251-6444
Mailing Address - Fax:718-531-2294
Practice Address - Street 1:5507 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1113
Practice Address - Country:US
Practice Address - Phone:718-251-6444
Practice Address - Fax:718-531-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00269241Medicaid
3303574OtherNABP