=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467954958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POUND RIDGE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2018
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 WESTCHESTER AVE
-----------------------------------------------------
City | POUND RIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10576-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-764-3330
-----------------------------------------------------
Fax | 914-764-3331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 106
-----------------------------------------------------
City | POUND RIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10576-0106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-662-9895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER & PHARMACY MANAGER/PIC/AO
-----------------------------------------------------
Name | SONALI COSTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-869-2130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 036439
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------