Provider Demographics
NPI: | 1629592001 |
---|---|
Name: | DOLSONTOWN PHARMACY CORP. |
Entity Type: | Organization |
Organization Name: | DOLSONTOWN PHARMACY CORP. |
Other - Org Name: | DOLSONTOWN PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PHARMACY MANAGER/OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PRATA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 914-224-6890 |
Mailing Address - Street 1: | 6 COLONIAL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | GOSHEN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10924-6411 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-224-6890 |
Mailing Address - Fax: | 845-775-4185 |
Practice Address - Street 1: | 1291 DOLSONTOWN RD STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | MIDDLETOWN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10940-4772 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-775-4175 |
Practice Address - Fax: | 845-775-4185 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-07-27 |
Last Update Date: | 2017-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 035557 | 333600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy |