Provider Demographics
NPI:1871581298
Name:MIL-RUE CHEMISTS, INC
Entity type:Organization
Organization Name:MIL-RUE CHEMISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-821-3271
Mailing Address - Street 1:6687 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3948
Mailing Address - Country:US
Mailing Address - Phone:718-821-3271
Mailing Address - Fax:718-386-9777
Practice Address - Street 1:6687 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3948
Practice Address - Country:US
Practice Address - Phone:718-821-3271
Practice Address - Fax:718-386-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008243333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00259036Medicaid