# FONTAK INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ryan Medical Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376946640
- **Authorized official:** MR. HOWARD JACOBSON RPH (PRESIDENT)
- **Authorized official phone:** (516) 459-5009

## Contact information

- **Practice address:** 2000 N VILLAGE AVE, SUITE 107, ROCKVILLE CENTRE, NY 11570-1078
- **Practice address phone:** (516) 362-2422
- **Practice address fax:** (516) 442-6111
- **Mailing address:** 2000 N VILLAGE AVE, SUITE 107, ROCKVILLE CENTRE, NY 11570-1078
- **Mailing address phone:** (516) 362-2422
- **Mailing address fax:** (516) 442-6111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | — | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |

## Other

- **Enumeration date:** 10/01/2014
- **Last updated:** 08/02/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7335660001 | MEDICARE PTAN | NY |