Organization
HAVILAND PHARMACY INC
Active
Other names
East Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARTHA JEAN JOLLY RPH (RPH OWNER)
(845) 229-2195
Entity
Organization
Contact information
Practice address
874 VIOLET AVE, HYDE PARK, NY 12538
(845) 229-2195
(845) 229-8700
Mailing address
874 VIOLET AVE, HYDE PARK, NY 12538
(845) 229-2195
(845) 229-8700
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
017019
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00768901
—
NY
01
—
3352755
NCPDP
—
Enumeration date
12/23/2005
Last updated
08/22/2020
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