1467663310 NPI number — PHARMACY OPERATIONS OF NEW YORK INC

Table of content: (NPI 1467663310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467663310 NPI number — PHARMACY OPERATIONS OF NEW YORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY OPERATIONS OF NEW YORK 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:
MEDICINE SHOPPE
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:
1467663310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 RIDER TRAIL PLAZA DRIVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
EARTH CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63045-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 BANK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE ROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14482-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-768-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERMAN
Authorized Official First Name:
DENA
Authorized Official Middle Name:
Authorized Official Title or Position:
THIRD PARTY PLAN COORDINATOR
Authorized Official Telephone Number:
314-993-6000

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  028503 , 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: 3354444 . This is a "NCPDP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02888695 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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