1518282011 NPI number — MR. DENNIS GERARD MOLLOY RPH. (PHARMACIST)

Table of content: MR. DENNIS GERARD MOLLOY RPH. (PHARMACIST) (NPI 1518282011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518282011 NPI number — MR. DENNIS GERARD MOLLOY RPH. (PHARMACIST)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLOY
Provider First Name:
DENNIS
Provider Middle Name:
GERARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH. (PHARMACIST)
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1518282011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 NORTH BROADWAY
Provider Second Line Business Mailing Address:
L&M PHARMACY ,INC (SMITH PHARMACY)
Provider Business Mailing Address City Name:
HICKSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-931-1099
Provider Business Mailing Address Fax Number:
516-931-4932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 N BROADWAY
Provider Second Line Business Practice Location Address:
SMITH PHARMACY
Provider Business Practice Location Address City Name:
HICKSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11801-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-931-1099
Provider Business Practice Location Address Fax Number:
516-931-4932
Provider Enumeration Date:
03/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  047191-1 , 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)





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