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Organization
KIDWELL INC
Active
Organization
KIDWELL INC
Active
Other names
the pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J WISTREICH RPH (SUPERVISING PHARMACIST)
(631) 582-5959
Entity
Organization
Contact information
Practice address
1770 MOTOR PARKWAY, HAUPPAUGE, NY 11749
(631) 582-5959
(631) 582-6043
Mailing address
1770 MOTOR PKWY, HAUPPAUGE, NY 11749-5260
(631) 582-5959
(631) 582-6043
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
31103
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021254
STATE PHARMACY LICENSE
NY
Enumeration date
08/15/2006
Last updated
10/21/2008
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