Healthcare Provider Details

I. General information

NPI: 1134772452
Provider Name (Legal Business Name): ALTO PHARMACY, LONG ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NEWTOWN RD STE 300
PLAINVIEW NY
11803-4300
US

IV. Provider business mailing address

645 HARRISON ST STE 200
SAN FRANCISCO CA
94107-3624
US

V. Phone/Fax

Practice location:
  • Phone: 800-874-5881
  • Fax:
Mailing address:
  • Phone: 800-874-5881
  • Fax: 415-484-7780

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier06271127
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: LAUREN HAMMOND
Title or Position: SR. MANAGER OF OPERATIONS
Credential:
Phone: 800-874-5881