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General NPI Number Information
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NPI Number | 1750441432
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Entity Type | Organization
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Legal Business Name | CUTCHOGUE DRUG STORE
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 28195 MAIN RD
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City | CUTCHOGUE
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State | NY
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Zip | 11935-1477
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Country | US
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Telephone | 631-734-6796
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 325
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City | CUTCHOGUE
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State | NY
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Zip | 11935
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Country | US
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Telephone | 631-734-6796
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALFRED TERP
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Credential |
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Telephone | 631-734-6796
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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 |
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License Number State |
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