Healthcare Provider Details

I. General information

NPI: 1447589361
Provider Name (Legal Business Name): TOWN TOTAL BAYSIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 FRANCIS LEWIS BLVD LOWER LEVEL
FLUSHING NY
11358-1145
US

IV. Provider business mailing address

2619 FRANCIS LEWIS BLVD LOWER LEVEL
FLUSHING NY
11358-1145
US

V. Phone/Fax

Practice location:
  • Phone: 718-971-1344
  • Fax: 718-971-1349
Mailing address:
  • Phone: 718-971-1344
  • Fax: 718-971-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number029923
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029923
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number029923
License Number StateNY

VIII. Authorized Official

Name: MR. JOSEPH P. NAVARRA
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: R.PH.
Phone: 212-213-5570