Healthcare Provider Details

I. General information

NPI: 1164669057
Provider Name (Legal Business Name): PDP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 05/31/2011
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: 516-593-9350
  • Fax: 516-599-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029282
License Number StateNY

VIII. Authorized Official

Name: JOSHUA MATHEW
Title or Position: PRESIDENT
Credential:
Phone: 516-761-2406