Organization
COUNTRY VILLAGE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK TRUNCALE (VP)
(631) 581-7878
Entity
Organization
Contact information
Practice address
242 E MAIN ST, EAST ISLIP, NY 11730-2712
(631) 581-7878
(631) 581-4712
Mailing address
242 E MAIN ST, EAST ISLIP, NY 11730-2712
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
010285
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3309300
OTHER ID NUMBER
—
Enumeration date
03/01/2007
Last updated
09/13/2007
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