MEDICARE: CUTCHOGUE DRUG STORE

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	183500000X	Pharmacist

General Provider Information

NPI Number	:	1750441432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTCHOGUE DRUG STORE

Provider Business Mailing Address
First Line	:	P O BOX 325
Second Line	:
City	:	CUTCHOGUE
State	:	NY
Zip	:	11935
Country	:	US
Telephone Number	:	631-734-6796
Fax Number	:

Provider Business Practice Location Address
First Line	:	28195 MAIN RD
Second Line	:
City	:	CUTCHOGUE
State	:	NY
Zip	:	11935-1477
Country	:	US
Telephone Number	:	631-734-6796
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALFRED TERP
Credential	:
Telephone Number	:	631-734-6796

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/29/2011

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Directions to “CUTCHOGUE DRUG STORE ” Practice Location

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