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General NPI Number Information
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NPI Number | 1417361791
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Entity Type | Organization
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Legal Business Name | LONG BEACH PHARMACY LLC.
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 251 W PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-3222
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Country | US
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Telephone | 516-889-8877
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Fax | 516-889-8876
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Provider Business Mailing Address
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Address Line | 251 W PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-3222
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Country | US
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Telephone | 516-889-8877
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Fax | 516-889-8876
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Authorized Official
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Title or Position | MEMBER
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Name | SRIHARI VUTUKURI
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Credential |
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Telephone | 516-889-8877
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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 | 032843
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License Number State | NY
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