Provider Demographics
NPI:1447396007
Name:DRUG DEPOT CORP
Entity type:Organization
Organization Name:DRUG DEPOT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMAMOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-222-2330
Mailing Address - Street 1:1601 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6991
Mailing Address - Country:US
Mailing Address - Phone:718-299-9600
Mailing Address - Fax:718-299-9602
Practice Address - Street 1:1601 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-299-9600
Practice Address - Fax:718-299-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0280893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3353098OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3353098OtherNCPDP PROVIDER IDENTIFICATION NUMBER