Organization
PHOENICIA PHARMACY
Active
Other names
PHOENICIA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN MILLMAN (OWNER)
(845) 688-2215
Entity
Organization
Contact information
Practice address
41 MAIN ST, PHOENICIA, NY 12464-5211
(845) 688-2215
(845) 688-2917
Mailing address
41 MAIN ST, PHOENICIA, NY 12464-5211
(845) 688-2215
(845) 688-2917
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
017198
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00628813
—
NY
01
—
2061114
PK
—
Enumeration date
12/04/2006
Last updated
01/27/2014
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