Provider Demographics
NPI:1841359627
Name:S & M PHARMACY
Entity type:Organization
Organization Name:S & M PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:POMPER
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:718-544-4656
Mailing Address - Street 1:68-50 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-544-4656
Mailing Address - Fax:718-261-2114
Practice Address - Street 1:6850 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1325
Practice Address - Country:US
Practice Address - Phone:718-544-4656
Practice Address - Fax:718-261-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0127223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00259247Medicaid
NY0326970001Medicare NSC