Provider Demographics
NPI:1154468361
Name:SHARON LYNN PHARMACY INC
Entity Type:Organization
Organization Name:SHARON LYNN PHARMACY INC
Other - Org Name:DRUGTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MS
Authorized Official - Phone:718-381-3014
Mailing Address - Street 1:64-16 MURTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6203
Mailing Address - Country:US
Mailing Address - Phone:718-381-3014
Mailing Address - Fax:718-417-4699
Practice Address - Street 1:64-16 MURTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6203
Practice Address - Country:US
Practice Address - Phone:718-381-3014
Practice Address - Fax:718-417-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16843333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00486517Medicaid