Provider Demographics
NPI:1013943737
Name:GREATNECK CHEMISTS INC
Entity Type:Organization
Organization Name:GREATNECK CHEMISTS INC
Other - Org Name:GREAT NECK CHEMISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:516-482-0004
Mailing Address - Street 1:69 ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5614
Mailing Address - Country:US
Mailing Address - Phone:516-482-0004
Mailing Address - Fax:516-487-8729
Practice Address - Street 1:69 ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5614
Practice Address - Country:US
Practice Address - Phone:516-482-0004
Practice Address - Fax:516-487-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NY0196023336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01051674Medicaid
2064817OtherPK
0164260001Medicare NSC
3346637OtherOTHER ID NUMBER-COMMERCIAL NUMBER