=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861201584
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D & A APOTHECARY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 364 LONG BEACH RD
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11572-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-766-2288
-----------------------------------------------------
Fax | 516-766-0687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 364 LONG BEACH RD
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11572-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-766-2288
-----------------------------------------------------
Fax | 516-766-0687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISING PHARMACIST
-----------------------------------------------------
Name | DR. DANIEL MARC SIMON
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 516-766-2288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------