1043201742 NPI number — SLOCUM-DICKSON PHARMACY INC

Table of content: NANCY MARIE PARRIS (NPI 1639624083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043201742 NPI number — SLOCUM-DICKSON PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLOCUM-DICKSON PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLOCUM DICKSON PHARMACY INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043201742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1729 BURRSTONE RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
NEW HARTFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13413-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-798-1724
Provider Business Mailing Address Fax Number:
315-798-1507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1729 BURRSTONE RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
NEW HARTFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13413-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-798-1724
Provider Business Practice Location Address Fax Number:
315-798-1507
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PELLITTIERI
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
315-798-1724

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 019678 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3391086 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01061238 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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