Organization
MEDICAL GROUP PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL AUTLER RPH (SUPERVISING PHARMACIST)
(631) 588-8582
Entity
Organization
Contact information
Practice address
650 HAWKINS AVE, LAKE RONKONKOMA, NY 11779-2366
(631) 588-8582
(631) 588-8599
Mailing address
650 HAWKINS AVE, LAKE RONKONKOMA, NY 11779-2366
(631) 588-8582
(631) 588-8599
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
017633
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3375501
NCPOP
—
Enumeration date
09/14/2006
Last updated
08/22/2020
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