Provider Demographics
NPI:1740321967
Name:BARKERS PHARMACY INC.
Entity type:Organization
Organization Name:BARKERS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-298-8666
Mailing Address - Street 1:PO BOX 1443
Mailing Address - Street 2:195 LOVE LANE
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0989
Mailing Address - Country:US
Mailing Address - Phone:631-298-8666
Mailing Address - Fax:631-298-5616
Practice Address - Street 1:195 LOVE LANE
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-0989
Practice Address - Country:US
Practice Address - Phone:631-298-8666
Practice Address - Fax:631-298-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006613333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00623818Medicaid
NY3335862OtherNCPDP