Healthcare Provider Details

I. General information

NPI: 1003905795
Provider Name (Legal Business Name): S & D PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 SUNRISE HWY
LYNBROOK NY
11563-3017
US

IV. Provider business mailing address

493 SUNRISE HWY
LYNBROOK NY
11563-3017
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-9350
  • Fax: 516-599-9614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number017908
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DONG HEE KIM
Title or Position: PRES/PHARM
Credential: BS/MS/RPH
Phone: 516-593-9350