Provider Demographics
NPI:1811170376
Name:COMMACK DRUG AND SURGICAL AND GIFTS
Entity type:Organization
Organization Name:COMMACK DRUG AND SURGICAL AND GIFTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-499-4438
Mailing Address - Street 1:132 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3404
Mailing Address - Country:US
Mailing Address - Phone:631-499-4438
Mailing Address - Fax:631-499-4441
Practice Address - Street 1:132 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3404
Practice Address - Country:US
Practice Address - Phone:631-499-4438
Practice Address - Fax:631-499-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
NY0286633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3356892OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY6090800001Medicare NSC