Provider Demographics
NPI:1720172018
Name:B AND B HAMPTON DRUGS INC
Entity type:Organization
Organization Name:B AND B HAMPTON DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-728-4030
Mailing Address - Street 1:39 4 W MONTAUX HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-4001
Mailing Address - Country:US
Mailing Address - Phone:631-728-4030
Mailing Address - Fax:631-728-0627
Practice Address - Street 1:39 4 W MONTAUX HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-4001
Practice Address - Country:US
Practice Address - Phone:631-728-4030
Practice Address - Fax:631-728-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0121473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00619329Medicaid
2058536OtherPK
NY00619329Medicaid