Healthcare Provider Details

I. General information

NPI: 1891777116
Provider Name (Legal Business Name): SOUND SHORE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 4TH ST
MOUNT VERNON NY
10550-4002
US

IV. Provider business mailing address

107 W 4TH ST
MOUNT VERNON NY
10550-4002
US

V. Phone/Fax

Practice location:
  • Phone: 914-699-0235
  • Fax: 914-699-3540
Mailing address:
  • Phone: 914-699-0235
  • Fax: 914-699-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number023121
License Number StateNY

VIII. Authorized Official

Name: ROBERT SPIEL
Title or Position: PHARMACIST
Credential:
Phone: 914-699-0235