Mark I Hertz, RPH
Individual provider Active NPI Pharmacist · Hampton Bays, NY
NPI 1780916817 · NPPES record last updated Jan 29, 2010
Key facts
- NPI
- 1780916817
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 034123 (NY)
- Practice address
- 39 W Montauk Hwy Ste 4
Hampton Bays, NY 11946-4094 - Phone
- (631) 728-4030
- Fax
- (631) 728-0627
- NPI assigned
- Jan 29, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034123 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| B and B Hampton Drugs Inc | Current | Accepting new patients |
Locations
39 W Montauk Hwy
Ste 4
Hampton Bays, NY 11946
Phone (631) 728-4030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 034123 | NY | Yes |
Addresses
Primary practice location
39 W Montauk Hwy Ste 4
Hampton Bays, NY 11946-4094
Mailing address
39 W Montauk Hwy Ste 4
Hampton Bays, NY 11946-4094
Phone (631) 728-4030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00619329 | Medicaid | NY |
Other providers in Hampton Bays, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.