Healthcare Provider Details

I. General information

NPI: 1609804269
Provider Name (Legal Business Name): STONY BROOK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY STE 3 A
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

2500 NESCONSET HWY STE 3 A
STONY BROOK NY
11790-2555
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-4477
  • Fax: 631-751-4962
Mailing address:
  • Phone: 631-751-4477
  • Fax: 631-751-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number018464
License Number StateNY

VIII. Authorized Official

Name: MAX SALVATORE
Title or Position: OWNER
Credential:
Phone: 631-751-4477