Provider Demographics
NPI:1235640210
Name:SOUTH SHORE UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:SOUTH SHORE UNIVERSITY HOSPITAL
Other - Org Name:VIVO HEALTH PHARMACY AT SOUTH SHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, CHIEF EXPENSE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-894-5775
Mailing Address - Street 1:1983 MARCUS AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:631-894-5775
Mailing Address - Fax:631-894-5781
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8408
Practice Address - Country:US
Practice Address - Phone:631-894-5775
Practice Address - Fax:631-894-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0357633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy