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Organization
THE MEDICINE STORE INC
Active
Organization
THE MEDICINE STORE INC
Active
Other names
Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIS PAVLOU (PRESIDENT)
(631) 300-4670
Entity
Organization
Contact information
Practice address
5 CANDLEWOOD RD, BAY SHORE, NY 11706-2351
(631) 300-4670
(631) 300-4673
Mailing address
5 CANDLEWOOD RD, BAY SHORE, NY 11706-2351
(631) 300-4670
(631) 300-4673
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
028674
NY
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2069992
PK
—
05
—
2936345
—
NY
Enumeration date
12/04/2007
Last updated
02/27/2017
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