Organization
SOUTH STATION PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIEFER KIKOV PHARMD (PRESIDENT)
(917) 407-3104
Entity
Organization
Contact information
Practice address
26 S STATION PLZ, GREAT NECK, NY 11021-3531
(516) 708-1300
(516) 708-1303
Mailing address
26 S STATION PLZ, GREAT NECK, NY 11021-3531
(516) 708-1300
(516) 708-1303
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851849400
—
NY
Enumeration date
06/04/2019
Last updated
06/04/2019
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