Provider Demographics
NPI:1770716953
Name:HARBOR CHEMISTS INC
Entity type:Organization
Organization Name:HARBOR CHEMISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHABIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-785-0120
Mailing Address - Street 1:353 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4120
Mailing Address - Country:US
Mailing Address - Phone:516-785-0120
Mailing Address - Fax:
Practice Address - Street 1:72 BAYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1656
Practice Address - Country:US
Practice Address - Phone:516-628-2323
Practice Address - Fax:516-628-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X, 333600000X
NY0297813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03037840Medicaid
2122365OtherPK
3362869OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03137840Medicaid