4TH Ave Drug Store Inc
Organization Active NPI Community/Retail Pharmacy · Mount Vernon, NY
NPI 1295299535 · NPPES record last updated Jun 8, 2020
Key facts
- NPI
- 1295299535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- 4TH AVE DRUG STORE INC
- Practice address
- 26 S 4TH Ave
Mount Vernon, NY 10550-3105 - Phone
- (914) 863-0399
- Fax
- (914) 863-0397
- NPI assigned
- Jan 30, 2019
- Organization subpart
- No
Authorized official
- Name
- Bibi Esahack
- Title
- President
- Phone
- (914) 863-0399
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| 4TH Ave Drug Store Inc |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190710000075 | NY | DME Supplier - Pharmacy | 7719212059 | Practice locations: Mount Vernon, NY |
| O20220228001283 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719212059 | Practice locations: Mount Vernon, NY |
| O20260203000240 | NY | Part B Supplier - Pharmacy | 7719212059 | Practice locations: Mount Vernon, NY |
National Provider Directory
Locations
26 S 4th Ave
Mount Vernon, NY 10550
Phone (914) 863-0399
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
26 S 4TH Ave
Mount Vernon, NY 10550-3105
Mailing address
26 S 4TH Ave
Mount Vernon, NY 10550-3105
Phone (914) 863-0399
Other providers in Mount Vernon, NY
- 187 Cottage Avenue Corp
- 32 Proctor Pharmacy Inc.
- 4TH Avenue Dental PC
- A&Z Drug Store, Inc.
- Ab Surgical Supply Co., Inc.
- Jessica Abad
- Abdollah Yamani MD PC
All providers in Mount Vernon, NY · Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.