Provider Demographics
NPI:1174778112
Name:BRIDGEHAMPTON PHARMACY INC
Entity type:Organization
Organization Name:BRIDGEHAMPTON PHARMACY 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:CALNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-537-8884
Mailing Address - Street 1:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-2036
Mailing Address - Country:US
Mailing Address - Phone:631-537-8884
Mailing Address - Fax:631-537-8070
Practice Address - Street 1:2450 MONTAUK HWY STORE B
Practice Address - Street 2:
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932
Practice Address - Country:US
Practice Address - Phone:631-537-8884
Practice Address - Fax:631-537-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0290153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3359064OtherNCPDP PROVIDER IDENTIFICATION NUMBER