# NACSIP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Mahopac Pharmacy & Surgical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396073060
- **Authorized official:** NAGI WISSA (R.PH,CEO)
- **Authorized official phone:** (845) 208-0424

## Contact information

- **Practice address:** 559 ROUTE 6, MAHOPAC, NY 10541-4712
- **Practice address phone:** (845) 208-0424
- **Practice address fax:** (845) 208-0425
- **Mailing address:** 559 ROUTE 6, MAHOPAC, NY 10541-4712
- **Mailing address phone:** (845) 208-0424
- **Mailing address fax:** (845) 208-0425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 029930 | NY | Yes |

## Other

- **Enumeration date:** 11/18/2009
- **Last updated:** 04/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3364116 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |