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General NPI Number Information
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NPI Number | 1811225949
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Entity Type | Organization
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Legal Business Name | OLIVE TREE PHARMACY
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 106 RIDGE ST
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City | NEW YORK
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State | NY
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Zip | 10002-2554
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Country | US
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Telephone | 646-368-9960
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Fax | 646-368-9861
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Provider Business Mailing Address
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Address Line | 106 RIDGE ST
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City | NEW YORK
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State | NY
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Zip | 10002-2554
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Country | US
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Telephone | 646-368-9960
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Fax | 646-368-9861
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Authorized Official
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Title or Position | OWNER
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Name | SAMIR HAMTINI
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Credential |
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Telephone | 646-368-9960
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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 | 029889
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License Number State | NY
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