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General NPI Number Information
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NPI Number | 1699267120
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Entity Type | Organization
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Legal Business Name | 175 JERICHO PHARMACY CORP
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 175 JERICHO TPKE WEST LOBBY SUITE
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City | SYOSSET
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State | NY
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Zip | 11791-4532
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Country | US
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Telephone | 516-865-1151
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Fax | 844-440-2401
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Provider Business Mailing Address
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Address Line | 175 JERICHO TPKE LBBY SUITE
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City | SYOSSET
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State | NY
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Zip | 11791-4532
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Country | US
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Telephone | 516-865-1151
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Fax | 844-440-2401
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Authorized Official
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Title or Position | PRESIDENT
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Name | BENJAMIN TSADYK
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Credential |
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Telephone | 516-865-1151
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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 | 036613
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License Number State | NY
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