Organization
179ATLANTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NAZANIN GANJIAN (SUPERVISING PHARMACIST)
(516) 377-4050
Entity
Organization
Contact information
Practice address
179 ATLANTIC AVE, FREEPORT, NY 11520-4922
(516) 377-4050
(516) 378-1809
Mailing address
179 ATLANTIC AVE, FREEPORT, NY 11520-4922
(516) 377-4050
(516) 378-1809
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
049252
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02532929
—
NY
Enumeration date
09/28/2006
Last updated
02/15/2008
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