MEDICARE: WYANDANCH PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	024851	NY

General Provider Information

NPI Number	:	1275571192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYANDANCH PHARMACY INC

Provider Business Mailing Address
First Line	:	323 MERRITT AVE
Second Line	:
City	:	WYANDANCH
State	:	NY
Zip	:	11798-2328
Country	:	US
Telephone Number	:	631-253-4552
Fax Number	:	631-253-4557

Provider Business Practice Location Address
First Line	:	323 MERRITT AVE
Second Line	:
City	:	WYANDANCH
State	:	NY
Zip	:	11798-2328
Country	:	US
Telephone Number	:	631-253-4552
Fax Number	:	631-253-4557

Authorized Official
Title or Position	:	OWNER
Name	:	SUNDAS NAQVI
Credential	:
Telephone Number	:	347-484-1794

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/05/2023

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