Provider Demographics
NPI:1770639072
Name:SLATER PHARMACY INC
Entity Type:Organization
Organization Name:SLATER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-588-1590
Mailing Address - Street 1:407 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4239
Mailing Address - Country:US
Mailing Address - Phone:631-588-1590
Mailing Address - Fax:631-981-5681
Practice Address - Street 1:407 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4239
Practice Address - Country:US
Practice Address - Phone:631-588-1590
Practice Address - Fax:631-981-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00653250Medicaid
NY0995440001Medicare ID - Type Unspecified