Organization
BARDONIA PHARMACY LLC
Active
Other names
Bardonia Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SAMUEL (PRESIDENT)
(845) 507-0555
Entity
Organization
Contact information
Practice address
301 ROUTE 304 STE 4, BARDONIA, NY 10954-2146
(845) 507-0555
(845) 507-0012
Mailing address
301 ROUTE 304 STE 4, BARDONIA, NY 10954-2146
(845) 507-0555
(845) 507-0012
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
034625
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04625201
—
NY
01
—
2162341
PK
—
Enumeration date
08/16/2016
Last updated
05/31/2022
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