Organization
FAIRVIEW HILL REALTY CORP
Active
Other names
FAIRVIEW PHARMACY AND HOMECARE SUPPLY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NASTRO (PRESIDENT)
(631) 474-7828
Entity
Organization
Contact information
Practice address
4747 NESCONSET HWY, STE 10, PORT JEFFERSON STATION, NY 11776-2872
(631) 474-7828
(631) 474-7871
Mailing address
4747 NESCONSET HWY, STE 10, PORT JEFFERSON STATION, NY 11776-2872
(631) 474-7828
(631) 474-7871
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
022326
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01548030
—
NY
01
—
2061369
PK
—
Enumeration date
11/16/2006
Last updated
06/09/2016
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