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General NPI Number Information
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NPI Number | 1144304270
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Entity Type | Organization
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Legal Business Name | GLEN HEAD PHARMACY INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 699 GLEN COVE AVE
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City | GLEN HEAD
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State | NY
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Zip | 11545-1602
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Country | US
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Telephone | 516-676-1004
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Fax | 516-676-5407
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Provider Business Mailing Address
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Address Line | 699 GLEN COVE AVE
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City | GLEN HEAD
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State | NY
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Zip | 11545-1602
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Country | US
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Telephone | 516-676-1004
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Fax | 516-676-5407
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICKY VOHORA
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Credential | DO
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Telephone | 516-934-0095
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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