Healthcare Provider Details

I. General information

NPI: 1811397508
Provider Name (Legal Business Name): NELCO VET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BROOK AVE
DEER PARK NY
11729-7251
US

IV. Provider business mailing address

154 BROOK AVE
DEER PARK NY
11729-7251
US

V. Phone/Fax

Practice location:
  • Phone: 631-242-3662
  • Fax: 631-242-3290
Mailing address:
  • Phone: 631-242-3662
  • Fax: 631-242-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number032267
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO LOPEZ
Title or Position: OWNER
Credential:
Phone: 631-242-3662