Provider Demographics
NPI:1134937261
Name:FRESH POND CHEMISTS LLC
Entity type:Organization
Organization Name:FRESH POND CHEMISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:917-617-6248
Mailing Address - Street 1:6060 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3544
Mailing Address - Country:US
Mailing Address - Phone:917-617-6248
Mailing Address - Fax:
Practice Address - Street 1:6060 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3544
Practice Address - Country:US
Practice Address - Phone:917-617-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy