Healthcare Provider Details

I. General information

NPI: 1568503209
Provider Name (Legal Business Name): GREENVALE CHEMISTS AND SURGICAL SUPPLY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NORTHERN BLVD
GREENVALE NY
11548-1204
US

IV. Provider business mailing address

5 NORTHERN BLVD
GREENVALE NY
11548-1204
US

V. Phone/Fax

Practice location:
  • Phone: 516-621-2260
  • Fax: 516-625-3843
Mailing address:
  • Phone: 516-621-2260
  • Fax: 516-625-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3332171
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J RADUAZZO SR.
Title or Position: OWNER
Credential: BS,PH
Phone: 516-621-2260