Organization
NACSIP INC
Active
Other names
Lake Mahopac Pharmacy & Surgical
Organization subpart
No
Provider details
NPI number
Authorized official
NAGI WISSA (R.PH,CEO)
(845) 208-0424
Entity
Organization
Contact information
Practice address
559 ROUTE 6, MAHOPAC, NY 10541-4712
(845) 208-0424
(845) 208-0425
Mailing address
559 ROUTE 6, MAHOPAC, NY 10541-4712
(845) 208-0424
(845) 208-0425
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
029930
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3364116
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/18/2009
Last updated
04/01/2011
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