Provider Demographics
NPI:1558486019
Name:FRANWIN PHARMACY MINEOLA SURGICAL SUPPLY CORP
Entity Type:Organization
Organization Name:FRANWIN PHARMACY MINEOLA SURGICAL SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-746-4720
Mailing Address - Street 1:127 MINEOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3917
Mailing Address - Country:US
Mailing Address - Phone:516-746-4720
Mailing Address - Fax:
Practice Address - Street 1:127 MINEOLA BLVD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3917
Practice Address - Country:US
Practice Address - Phone:516-746-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022147332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00426206Medicaid
NY00426206Medicaid