Provider Demographics
NPI:1154192821
Name:SAND LANE DRUGS INC
Entity type:Organization
Organization Name:SAND LANE DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELTSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:347-525-4505
Mailing Address - Street 1:337 SAND LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4500
Mailing Address - Country:US
Mailing Address - Phone:347-466-5179
Mailing Address - Fax:347-466-5184
Practice Address - Street 1:337 SAND LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4500
Practice Address - Country:US
Practice Address - Phone:347-466-5179
Practice Address - Fax:347-466-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy