Provider Demographics
NPI:1427397322
Name:STONYBROOK PHARMACY LLC
Entity Type:Organization
Organization Name:STONYBROOK PHARMACY LLC
Other - Org Name:STONYBROOK PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-226-8779
Mailing Address - Street 1:13921 S PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2916
Mailing Address - Country:US
Mailing Address - Phone:866-226-8779
Mailing Address - Fax:877-300-3649
Practice Address - Street 1:13921 S PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2916
Practice Address - Country:US
Practice Address - Phone:801-727-0086
Practice Address - Fax:877-300-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138762OtherPK