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General NPI Number Information
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NPI Number | 1588955330
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Entity Type | Organization
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Legal Business Name | LAURELTON CHEMIST INC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 07/22/2011
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Provider Practice Location Address
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Address Line | 22412 MERRICK BLVD
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City | LAURELTON
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State | NY
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Zip | 11413-2023
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Country | US
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Telephone | 718-977-0700
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Fax | 718-977-0701
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Provider Business Mailing Address
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Address Line | 22412 MERRICK BLVD
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City | LAURELTON
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State | NY
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Zip | 11413-2023
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Country | US
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Telephone | 718-977-0700
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Fax | 718-977-0701
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SYED SHAH
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Credential |
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Telephone | 917-257-8225
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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 | 030620
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License Number State | NY
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