MEDICARE: MAHOPAC 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	333600000X	Pharmacy	019627	NY

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	:	1962493452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHOPAC PHARMACY INC.

Provider Business Mailing Address
First Line	:	936 S LAKE BLVD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-3242
Country	:	US
Telephone Number	:	845-628-5600
Fax Number	:	845-628-0219

Provider Business Practice Location Address
First Line	:	936 S LAKE BLVD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-3242
Country	:	US
Telephone Number	:	845-628-5600
Fax Number	:	845-628-0219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LAURENCE MIRESSI
Credential	:
Telephone Number	:	845-628-5600

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	02/08/2008

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