Organization
P & G PHARMACY INC
Active
Other names
COUNTY LINE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD GAWRYSIAK (PRESIDENT)
(631) 249-6400
Entity
Organization
Contact information
Practice address
1111 ROUTE 110, FARMINGDALE, NY 11735-4820
(631) 249-6400
(631) 249-6401
Mailing address
1111 ROUTE 110, FARMINGDALE, NY 11735-4820
(631) 249-6400
(631) 249-6401
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
017498
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00717991
—
NY
01
—
2064050
PK
—
Enumeration date
02/12/2007
Last updated
03/11/2024
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