Provider Demographics
NPI:1457562423
Name:PARK PLACE CHEMISTS, INC
Entity Type:Organization
Organization Name:PARK PLACE CHEMISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:631-324-6660
Mailing Address - Street 1:200 PANTIGO PL STE K
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-5923
Mailing Address - Country:US
Mailing Address - Phone:631-324-6660
Mailing Address - Fax:631-324-3515
Practice Address - Street 1:200 PANTIGO PL STE K
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5923
Practice Address - Country:US
Practice Address - Phone:631-324-6660
Practice Address - Fax:631-324-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00541057Medicaid