Healthcare Provider Details

I. General information

NPI: 1659437531
Provider Name (Legal Business Name): SHORE DRUGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E MAIN ST
BAY SHORE NY
11706-8301
US

IV. Provider business mailing address

30 E MAIN ST
BAY SHORE NY
11706-8301
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-3000
  • Fax: 631-206-1246
Mailing address:
  • Phone: 631-665-3000
  • Fax: 631-206-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020657
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LARRY LEON
Title or Position: PRES
Credential: RPH
Phone: 631-665-3000