Organization
CALJEB PHARMACY CORP
Active
Other names
LIGHTHOUSE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK FAWCETT MBA (CEO)
(631) 654-2444
Entity
Organization
Contact information
Practice address
747 MONTAUK HIGHWAY, PATCHOGUE, NY 11772
(631) 654-2444
(631) 654-1837
Mailing address
747 MONTAUK HIGHWAY, PATCHOGUE, NY 11772
(631) 654-2444
(631) 654-1837
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
016177
NY
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00628717
—
NY
01
—
2060288
PK
—
Enumeration date
05/27/2005
Last updated
03/24/2017
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