=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013044858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAFORD CHEMISTS QUAILE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 09/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1696 WASHINGTON AVE
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11783-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-781-3115
-----------------------------------------------------
Fax | 516-781-3119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1696 WASHINGTON AVE
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11783-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GERARD ZIMMERMANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-781-3115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 018922
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------