Provider Demographics
NPI:1023113677
Name:MEACHAM PHARMACY
Entity type:Organization
Organization Name:MEACHAM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:S P
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENINCASA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH BS
Authorized Official - Phone:516-354-2950
Mailing Address - Street 1:107 MEACHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2630
Mailing Address - Country:US
Mailing Address - Phone:516-354-2950
Mailing Address - Fax:516-354-3375
Practice Address - Street 1:107 MEACHAM AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2630
Practice Address - Country:US
Practice Address - Phone:516-354-2950
Practice Address - Fax:516-354-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0152623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00378083Medicaid
3353923OtherOTHER ID NUMBER
0175250001Medicare NSC