Provider Demographics
NPI:1386789543
Name:GREATNECK CHEMISTS INC
Entity type:Organization
Organization Name:GREATNECK CHEMISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:516-482-0004
Mailing Address - Street 1:69 ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5614
Mailing Address - Country:US
Mailing Address - Phone:516-482-0004
Mailing Address - Fax:516-487-8729
Practice Address - Street 1:69 ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5614
Practice Address - Country:US
Practice Address - Phone:516-482-0004
Practice Address - Fax:516-487-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0196023336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065113OtherPK
NY01051674Medicaid
NY01051674Medicaid