MEDICARE: SAG HARBOR PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1609548650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAG HARBOR PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 1050
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MAIN ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3007
Country	:	US
Telephone Number	:	631-725-0072
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TARIQUE CHAUDHARY
Credential	:
Telephone Number	:	631-899-2526

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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