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General NPI Number Information
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NPI Number | 1568503209
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Entity Type | Organization
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Legal Business Name | GREENVALE CHEMISTS AND SURGICAL SUPPLY CO
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 5 NORTHERN BLVD
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City | GREENVALE
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State | NY
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Zip | 11548-1204
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Country | US
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Telephone | 516-621-2260
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Fax | 516-625-3843
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Provider Business Mailing Address
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Address Line | 5 NORTHERN BLVD
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City | GREENVALE
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State | NY
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Zip | 11548-1204
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Country | US
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Telephone | 516-621-2260
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Fax | 516-625-3843
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL J RADUAZZO SR.
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Credential | BS,PH
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Telephone | 516-621-2260
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3332171
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License Number State | NY
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