Healthcare Provider Details

I. General information

NPI: 1629443825
Provider Name (Legal Business Name): WOODSIDE CHEMISTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 WOODSIDE AVE STORE #3
WOODSIDE NY
11377-3437
US

IV. Provider business mailing address

5801 WOODSIDE AVE STORE #3
WOODSIDE NY
11377-3437
US

V. Phone/Fax

Practice location:
  • Phone: 929-522-0324
  • Fax: 929-522-0567
Mailing address:
  • Phone: 929-522-0324
  • Fax: 929-522-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034237
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONIKA SONI
Title or Position: OWNER
Credential:
Phone: 916-479-0838