Healthcare Provider Details

I. General information

NPI: 1780134833
Provider Name (Legal Business Name): 31ST & 3RD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WALT WHITMAN RD SUITE 700
MELVILLE NY
11747-3282
US

IV. Provider business mailing address

1860 WALT WHITMAN RD SUITE 700
MELVILLE NY
11747-3282
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number027550
License Number StateNY

VIII. Authorized Official

Name: AL M DOSSANTOS
Title or Position: FOUNDING PRINCIPAL
Credential: RPH
Phone: 516-822-6300