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General NPI Number Information
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NPI Number | 1730270083
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Entity Type | Organization
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Legal Business Name | 179ATLANTIC INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 179 ATLANTIC AVE
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City | FREEPORT
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State | NY
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Zip | 11520-4922
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Country | US
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Telephone | 516-377-4050
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Fax | 516-378-1809
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Provider Business Mailing Address
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Address Line | 179 ATLANTIC AVE
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City | FREEPORT
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State | NY
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Zip | 11520-4922
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Country | US
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Telephone | 516-377-4050
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Fax | 516-378-1809
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MS. NAZANIN GANJIAN
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Credential |
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Telephone | 516-377-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 049252
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License Number State | NY
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