1063869238 NPI number — MIDDLETOWN LTC PHARMACY LLC

Table of content: (NPI 1063869238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063869238 NPI number — MIDDLETOWN LTC PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLETOWN LTC PHARMACY LLC
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:
HUDSON REGIONAL LTC PHARMACY
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:
1063869238
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:
280 ROUTE 211 E
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-341-2700
Provider Business Mailing Address Fax Number:
845-341-2715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 ROUTE 211 E
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-341-2700
Provider Business Practice Location Address Fax Number:
845-341-2715
Provider Enumeration Date:
05/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MAYUR
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
845-341-2700

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04585449 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034715 . This is a "STATE BOARD OF PHARMACY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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