Provider Demographics
NPI:1346747656
Name:NSD PHARMACY CORP
Entity Type:Organization
Organization Name:NSD PHARMACY CORP
Other - Org Name:HICKSVILLE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-396-0608
Mailing Address - Street 1:495 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5040
Mailing Address - Country:US
Mailing Address - Phone:516-396-0608
Mailing Address - Fax:516-396-0609
Practice Address - Street 1:495 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5040
Practice Address - Country:US
Practice Address - Phone:516-396-0608
Practice Address - Fax:516-396-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177043OtherPK