Provider Demographics
NPI:1649318767
Name:THALES WELL PHARMACY INC
Entity type:Organization
Organization Name:THALES WELL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:ALAM
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-549-4900
Mailing Address - Street 1:1785 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1727
Mailing Address - Country:US
Mailing Address - Phone:631-549-4900
Mailing Address - Fax:631-549-4197
Practice Address - Street 1:1785 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1727
Practice Address - Country:US
Practice Address - Phone:631-549-4900
Practice Address - Fax:631-549-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02640751Medicaid