MEDICARE: DOCTORS PHARMACY

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	018821	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3385704	OTHER	NY	NABP
2	018821	OTHER	NY	STORE STATE LICENSE NUMBE

General Provider Information

NPI Number	:	1821216185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS PHARMACY

Provider Business Mailing Address
First Line	:	535 PORT WASHINGTON BLVD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-4217
Country	:	US
Telephone Number	:	516-883-0530
Fax Number	:	516-883-0530

Provider Business Practice Location Address
First Line	:	535 PORT WASHINGTON BLVD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-4217
Country	:	US
Telephone Number	:	516-883-0530
Fax Number	:	516-883-0530

Authorized Official
Title or Position	:	OWNER-RPH-SP
Name	:	MR. FRED SALVATORE DELUCIA SR.
Credential	:	B.S.-RPH
Telephone Number	:	516-883-0530

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	03/07/2023

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Directions to “DOCTORS PHARMACY ” Practice Location

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