Provider Demographics
NPI:1003800871
Name:LOCUST VALLEY CHEMISTS
Entity Type:Organization
Organization Name:LOCUST VALLEY CHEMISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-656-9090
Mailing Address - Street 1:60 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1714
Mailing Address - Country:US
Mailing Address - Phone:516-656-9090
Mailing Address - Fax:516-656-0907
Practice Address - Street 1:60 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1714
Practice Address - Country:US
Practice Address - Phone:516-656-9090
Practice Address - Fax:516-656-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02590747Medicaid
NY026812OtherLICENSE NUMBER
NY02590747Medicaid