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General NPI Number Information
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NPI Number | 1679603591
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Entity Type | Organization
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Legal Business Name | P D L DRUG STORE INC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 95 THE PLZ
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City | MONTAUK
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State | NY
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Zip | 11954-4000
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Country | US
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Telephone | 631-668-2994
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Fax | 631-668-1109
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Provider Business Mailing Address
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Address Line | PO BOX 940
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City | MONTAUK
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State | NY
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Zip | 11954-0740
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Country | US
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Telephone | 631-668-2994
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Fax | 631-668-1109
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. DERYN TROTT
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Credential |
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Telephone | 631-668-2994
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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 | 016022
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License Number State | NY
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