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General NPI Number Information
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NPI Number | 1457790503
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Entity Type | Organization
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Legal Business Name | D.R.A. PHARMAKON INC
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 389-391 PENINSULA BLVD STE E
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City | HEMPSTEAD
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State | NY
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Zip | 11550-4914
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Country | US
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Telephone | 516-280-4100
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Fax | 516-280-4155
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Provider Business Mailing Address
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Address Line | 389-391 PENINSULA BLVD STORE E
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City | HEMPSTEAD
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State | NY
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Zip | 11550-4914
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Country | US
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Telephone | 516-280-4100
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Fax | 516-280-4155
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Authorized Official
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Title or Position | RPH
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Name | MR. DEMETRIS PAVLOU
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Credential |
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Telephone | 516-280-4100
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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 | 031987
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License Number State | NY
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