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Organization
PHARMACY 112 INC.
Active
Organization
PHARMACY 112 INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL KOLLER (COO)
(631) 475-4141
Entity
Organization
Contact information
Practice address
2608 ROUTE 112 # B, MEDFORD, NY 11763-2551
(631) 438-0530
Mailing address
2608 ROUTE 112, MEDFORD, NY 11763-2551
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
032401
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032401
REGISTRATION
NY
01
—
1598186595
NPI
NY
Enumeration date
12/18/2013
Last updated
10/27/2015
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