Healthcare Provider Details

I. General information

NPI: 1912732751
Provider Name (Legal Business Name): MONTAUK CHEMISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MONTAUK HWY
MASTIC NY
11950-2917
US

IV. Provider business mailing address

353 NEWBRIDGE RD
EAST MEADOW NY
11554-4120
US

V. Phone/Fax

Practice location:
  • Phone: 631-729-3720
  • Fax: 631-729-3722
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RANDOLPH MOHABIR
Title or Position: OWNER
Credential:
Phone: 516-785-0120