Provider Demographics
NPI:1184322349
Name:MINEOLA PHARMACY INC.
Entity type:Organization
Organization Name:MINEOLA PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCISCI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:516-427-5573
Mailing Address - Street 1:182 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4021
Mailing Address - Country:US
Mailing Address - Phone:516-427-5573
Mailing Address - Fax:516-427-5574
Practice Address - Street 1:182 2ND ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4021
Practice Address - Country:US
Practice Address - Phone:516-427-5573
Practice Address - Fax:516-427-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy