Organization · NPI-2
Waldbaum INC
Pharmacy · Stony Brook, NY
NPI number1477578938
StatusActive
Last updated in NPPESNov 18, 2007
Details
- NPI
- 1477578938
- Entity type
- Organization (NPI-2)
- Legal business name
- Waldbaum INC
- Organization subpart
- Yes
- Enumeration date
- Jul 13, 2006
- Last updated
- Nov 18, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | 023413 | NY | Yes |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 023413 | NY |
Other names
- Waldbaums Pharmacy (Doing Business As)
Practice location
2162 Nesconset HwyStony Brook, NY 11790-3503
Phone 631-444-0968 · Fax 631-444-0963
Mailing address
2162 Nesconset HwyStony Brook, NY 11790-3503
Authorized official
Susan Kijowski
Pharmacy Specialist
2015718326
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