Provider Demographics
NPI:1548367485
Name:S-A DRUG CORP
Entity type:Organization
Organization Name:S-A DRUG CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-378-0003
Mailing Address - Street 1:1612 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2915
Mailing Address - Country:US
Mailing Address - Phone:718-378-0003
Mailing Address - Fax:
Practice Address - Street 1:1612 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2915
Practice Address - Country:US
Practice Address - Phone:718-378-0003
Practice Address - Fax:718-378-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NY018290333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3380994OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY23122421Medicaid