Provider Demographics
NPI:1740392752
Name:PLAINVIEW FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:PLAINVIEW FAMILY PHARMACY INC
Other - Org Name:PLAINVIEW FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMOUHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-932-7077
Mailing Address - Street 1:142A MANETTO HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1310
Mailing Address - Country:US
Mailing Address - Phone:516-932-7077
Mailing Address - Fax:516-932-1971
Practice Address - Street 1:142A MANETTO HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1310
Practice Address - Country:US
Practice Address - Phone:516-932-7077
Practice Address - Fax:516-932-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0243843336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01952703Medicaid
2058535OtherPK
1274470001Medicare NSC