MEDICARE: CONTIGO PHARMACY WNY CORP

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1487424669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTIGO PHARMACY WNY CORP

Provider Business Mailing Address
First Line	:	5408 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-4622
Country	:	US
Telephone Number	:	201-940-8882
Fax Number	:	201-940-8887

Provider Business Practice Location Address
First Line	:	5408 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-4622
Country	:	US
Telephone Number	:	201-940-8882
Fax Number	:	201-940-8887

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	JEANETTE MARTINEZ
Credential	:	PHARM.D
Telephone Number	:	201-940-8882

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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