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General NPI Number Information
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NPI Number | 1740295344
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Entity Type | Organization
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Legal Business Name | FAMILY DRUG STORE
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 524 BROADWAY
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City | MONTICELLO
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State | NY
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Zip | 12701-1154
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Country | US
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Telephone | 845-794-2345
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Fax | 845-794-0170
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Provider Business Mailing Address
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Address Line | 524 BROADWAY
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City | MONTICELLO
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State | NY
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Zip | 12701-1154
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Country | US
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Telephone | 845-794-2345
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Fax | 914-794-0170
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Authorized Official
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Title or Position | OWNER
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Name | ALAN COHEN
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Credential | RPH
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Telephone | 845-794-2345
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 019340
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License Number State | NY
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