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General NPI Number Information
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NPI Number | 1316492721
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Entity Type | Organization
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Legal Business Name | BARDONIA PHARMACY LLC
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 301 ROUTE 304 STE 4
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City | BARDONIA
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State | NY
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Zip | 10954-2146
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Country | US
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Telephone | 845-507-0555
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Fax | 845-507-0012
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Provider Business Mailing Address
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Address Line | 301 ROUTE 304 STE 4
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City | BARDONIA
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State | NY
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Zip | 10954-2146
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Country | US
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Telephone | 845-507-0555
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Fax | 845-507-0012
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN SAMUEL
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Credential |
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Telephone | 845-507-0555
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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 | 3336C0004X
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Taxonomy Name | Compounding 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 | 034625
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License Number State | NY
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