MEDICARE: MIDDLETOWN LTC PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	034715	OTHER	NY	STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1063869238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLETOWN LTC PHARMACY LLC

Provider Business Mailing Address
First Line	:	280 ROUTE 211 E
Second Line	:	SUITE 112
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-3109
Country	:	US
Telephone Number	:	845-341-2700
Fax Number	:	845-341-2715

Provider Business Practice Location Address
First Line	:	280 ROUTE 211 E
Second Line	:	SUITE 112
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-3109
Country	:	US
Telephone Number	:	845-341-2700
Fax Number	:	845-341-2715

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	03/07/2023

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Directions to “MIDDLETOWN LTC PHARMACY LLC ” Practice Location

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