NPIMap

Organization Active NPI

Civa Drug Corp

  • Long Term Care Pharmacy
  • Brentwood, NY
National Provider Identifier
1336837780
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
CIVA DRUG CORP
Practice address
761 Suffolk Ave
Brentwood, NY 11717-4409
Phone
(631) 273-3314
Fax
(631) 273-8863
NPI assigned
Apr 25, 2023
Organization subpart
Yes
Parent organization
CIVA DRUG CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Digesh C ThakerNPI 1104148873
Title
Supervising Pharmacist
Phone
(631) 273-3314

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

761 Suffolk Ave
Brentwood, NY 11717-4409

Mailing address

761 Suffolk Ave
Brentwood, NY 11717-4409
Phone (631) 273-3314

Other identifiers 1

IdentifierTypeStateIssuer
00713240MedicaidNY

Other names 1

  • Brentwood Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Civa Drug Corp2 organizations share this tax ID, including this one
Part of
Civa Drug Corp

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

761 Suffolk Ave
Brentwood, NY 11717
Phone (631) 273-3314

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1336837780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 SUFFOLK AVE",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117174409",
            "telephone_number": "631-273-3314",
            "fax_number": "631-273-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 SUFFOLK AVE",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117174409",
            "telephone_number": "631-273-3314",
            "fax_number": "631-273-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVA DRUG CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIVA DRUG CORP",
        "enumeration_date": "2023-04-25",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-14",
        "status": "A",
        "authorized_official_last_name": "THAKER",
        "authorized_official_first_name": "DIGESH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SUPERVISING PHARMACIST",
        "authorized_official_telephone_number": "631-273-3314"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00713240",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brentwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brentwood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.