MEDICARE: THALES WELL 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	3336I0012X	Institutional Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649318767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THALES WELL PHARMACY INC

Provider Business Mailing Address
First Line	:	1785 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-1727
Country	:	US
Telephone Number	:	631-549-4900
Fax Number	:	631-549-4197

Provider Business Practice Location Address
First Line	:	1785 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-1727
Country	:	US
Telephone Number	:	631-549-4900
Fax Number	:	631-549-4197

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MANSOOR ALAM MALIK
Credential	:
Telephone Number	:	631-549-4900

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/20/2007

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