1780134833 NPI number — 31ST & 3RD PHARMACY INC

Table of content: (NPI 1780134833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780134833 NPI number — 31ST & 3RD PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
31ST & 3RD PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARAMOUNT SPECIALTY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780134833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 WALT WHITMAN RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-3282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-822-6300
Provider Business Mailing Address Fax Number:
516-822-6333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 WALT WHITMAN RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
MELVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11747-3282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-822-6300
Provider Business Practice Location Address Fax Number:
516-822-6333
Provider Enumeration Date:
10/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DOSSANTOS
Authorized Official First Name:
AL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FOUNDING PRINCIPAL
Authorized Official Telephone Number:
516-822-6300

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  027550 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02700609 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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