Provider Demographics
NPI:1770708463
Name:PHAMCO INC.
Entity type:Organization
Organization Name:PHAMCO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TANAPONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTASRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-477-1111
Mailing Address - Street 1:100 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1616
Mailing Address - Country:US
Mailing Address - Phone:631-477-1111
Mailing Address - Fax:631-477-1218
Practice Address - Street 1:100 FRONT ST
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1616
Practice Address - Country:US
Practice Address - Phone:631-477-1111
Practice Address - Fax:631-477-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0254403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
025440OtherBOARD OF PHARMACY
NY3332169OtherNABP NUMBER
NY3332169OtherNABP NUMBER