Organization
GLEN COVE PHARM LLC
Active
Other names
GLEN COVE CHEMISTS
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAN JOLLY RPH (OWNER)
(516) 676-9111
Entity
Organization
Contact information
Practice address
20 FOREST AVE, GLEN COVE, NY 11542-2106
(516) 676-9111
(516) 676-5162
Mailing address
20 FOREST AVE, GLEN COVE, NY 11542-2106
(516) 676-9111
(516) 676-5162
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
025220
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02205301
—
NY
01
—
2063681
PK
—
Enumeration date
03/22/2007
Last updated
10/24/2014
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