Provider Demographics
NPI:1871166165
Name:ELDRIDGE STREET PHARMACY INC
Entity type:Organization
Organization Name:ELDRIDGE STREET PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DE FU
Authorized Official - Middle Name:
Authorized Official - Last Name:ZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-755-8268
Mailing Address - Street 1:11 ELDRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6233
Mailing Address - Country:US
Mailing Address - Phone:646-755-8268
Mailing Address - Fax:646-755-8284
Practice Address - Street 1:11 ELDRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6233
Practice Address - Country:US
Practice Address - Phone:646-755-8268
Practice Address - Fax:646-755-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy