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Organization

SHORE PHARMACEUTICAL PROVIDERS

Active
Parent organization
OMNICAREESC LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
OMNICAREESC LLC
Authorized official
MR. IVAN GORDON (CEO)
(516) 938-8080
Entity
Organization

Contact information

Practice address
24812 82ND AVE, BELLEROSE, NY 11426-2502
(718) 347-4844
Mailing address
24812 82ND AVE, BELLEROSE, NY 11426-2502
(718) 347-4844

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
33065
NY

Other

Enumeration date
02/25/2010
Last updated
03/03/2010
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