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General NPI Number Information
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NPI Number | 1063083897
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Entity Type | Organization
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Legal Business Name | PET DRUG STORE INC.
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 700 UNION PKWY STE 6
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City | RONKONKOMA
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State | NY
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Zip | 11779-7427
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Country | US
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Telephone | 631-648-9530
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Fax |
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Provider Business Mailing Address
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Address Line | 700 UNION PKWY STE 6
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City | RONKONKOMA
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State | NY
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Zip | 11779-7427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | KRISTINA GARFINKEL
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Credential |
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Telephone | 516-648-9530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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