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General NPI Number Information
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NPI Number | 1255345005
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Entity Type | Organization
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Legal Business Name | OLD COUNTRY PHARMACY INC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 10 HONEY LOCUST CT
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City | DIX HILLS
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State | NY
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Zip | 11746-6253
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Country | US
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Telephone | 516-551-0775
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Fax | 516-551-0775
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Provider Business Mailing Address
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Address Line | 601 OLD COUNTRY RD
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City | WESTBURY
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State | NY
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Zip | 11590-4511
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Country | US
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Telephone | 516-270-3965
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Fax | 516-502-6238
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MITCHEL MELONE
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Credential | RPH
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Telephone | 516-270-3965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 027854
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License Number State | NY
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