=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730259995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHMOND PHARMACY & SURGICALS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 06/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1796 CLOVE RD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-1672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-447-1206
-----------------------------------------------------
Fax | 718-981-3638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1796 CLOVE RD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-1672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-447-1206
-----------------------------------------------------
Fax | 718-981-3638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. GEORGE P DROGARIS
-----------------------------------------------------
Credential | MS RPH
-----------------------------------------------------
Telephone | 718-447-1206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 019959
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------