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General NPI Number Information
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NPI Number | 1356609143
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Entity Type | Organization
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Legal Business Name | NEW DORP PHARMACY CORP
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 62 NEW DORP PLZ
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2920
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Country | US
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Telephone | 718-667-6668
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Fax | 718-667-6665
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Provider Business Mailing Address
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Address Line | 62 NEW DORP PLZ
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2920
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Country | US
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Telephone | 718-667-6668
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Fax | 718-667-6665
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAVEL LERMAN
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Credential |
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Telephone | 718-667-6668
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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 | 031161
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License Number State | NY
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