1629592001 NPI number — DOLSONTOWN PHARMACY CORP.

Table of content: SARA UNGER LPCC-S (NPI 1295271567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629592001 NPI number — DOLSONTOWN PHARMACY CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOLSONTOWN PHARMACY CORP.
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:
Provider Other Organization Name Type Code:
6
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:
1629592001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 COLONIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10924-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-224-6890
Provider Business Mailing Address Fax Number:
845-775-4185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1291 DOLSONTOWN RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-4772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-775-4175
Provider Business Practice Location Address Fax Number:
845-775-4185
Provider Enumeration Date:
07/27/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRATA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER/OWNER
Authorized Official Telephone Number:
914-224-6890

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  035557 , 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)