# PHARMACY 112 INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598186595
- **Authorized official:** CRYSTAL KOLLER (COO)
- **Authorized official phone:** (631) 475-4141

## Contact information

- **Practice address:** 2608 ROUTE 112 \# B, MEDFORD, NY 11763-2551
- **Practice address phone:** (631) 438-0530
- **Mailing address:** 2608 ROUTE 112, MEDFORD, NY 11763-2551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 032401 | NY | Yes |

## Other

- **Enumeration date:** 12/18/2013
- **Last updated:** 10/27/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 032401 | REGISTRATION | NY |
| 01 | — | 1598186595 | NPI | NY |