Healthcare Provider Details

I. General information

NPI: 1881609428
Provider Name (Legal Business Name): 31ST & 3RD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WALT WHITMAN RD STE 700
MELVILLE NY
11747-3098
US

IV. Provider business mailing address

5700 GRANITE PARKWAY SUITE 425
PLANO TX
75024
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-6300
  • Fax: 516-822-6333
Mailing address:
  • Phone: 469-592-2011
  • Fax: 516-822-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number027550
License Number StateNY

VIII. Authorized Official

Name: CARL CODY COLQUITT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 469-850-6390