Provider Demographics
NPI:1821216185
Name:DOCTORS PHARMACY
Entity type:Organization
Organization Name:DOCTORS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-RPH-SP
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:BS-RPH
Authorized Official - Phone:516-883-0530
Mailing Address - Street 1:535 PORT WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4217
Mailing Address - Country:US
Mailing Address - Phone:516-883-0530
Mailing Address - Fax:516-883-0530
Practice Address - Street 1:535 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4217
Practice Address - Country:US
Practice Address - Phone:516-883-0530
Practice Address - Fax:516-883-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3385704OtherNABP
NY018821OtherSTORE STATE LICENSE NUMBE
NY018821OtherSTORE STATE LICENSE NUMBE