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General NPI Number Information
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NPI Number | 1245314087
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Entity Type | Organization
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Legal Business Name | SOUTHOLD PHARMACY INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 53895 MAIN RD
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City | SOUTHOLD
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State | NY
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Zip | 11971-4644
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Country | US
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Telephone | 631-765-3434
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Fax | 631-765-4395
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Provider Business Mailing Address
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Address Line | PO BOX 1177
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City | SOUTHOLD
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State | NY
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Zip | 11971-0957
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Country | US
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Telephone | 631-765-3434
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Fax | 631-765-4395
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Authorized Official
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Title or Position | OWNER
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Name | PAULETTE OFRIAS
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Credential |
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Telephone | 631-765-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 010139
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License Number State | NY
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