Organization
OLD COUNTRY PHARMACY INC
Active
Other names
PARKSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHEL MELONE RPH (OWNER/PRESIDENT)
(516) 270-3965
Entity
Organization
Contact information
Practice address
10 HONEY LOCUST CT, DIX HILLS, NY 11746-6253
(516) 551-0775
(516) 551-0775
Mailing address
601 OLD COUNTRY RD, WESTBURY, NY 11590-4511
(516) 270-3965
(516) 502-6238
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
027854
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02808919
—
NY
01
—
2068323
PK
—
Enumeration date
07/28/2006
Last updated
02/24/2016
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