Organization
MOMS PHARMACY INC
Active
Other names
MOMS PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSS FICHERA (SR VP, CFO)
(631) 870-5126
Entity
Organization
Contact information
Practice address
45 MELVILLE PARK RD, MELVILLE, NY 11747-3109
(631) 547-6520
(631) 249-5865
Mailing address
PO BOX 637302, CINCINNATI, OH 45263-0001
(631) 547-6520
(206) 202-4127
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021158
NY
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023990
—
NJ
05
—
003111672
—
CT
05
—
02533719
—
NY
01
—
3323324
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/03/2005
Last updated
05/09/2012
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