MEDICARE: OLDE CANAL PHARMACY INC

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	022482	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2057593	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811033426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLDE CANAL PHARMACY INC

Provider Business Mailing Address
First Line	:	201 SCOTTSVILLE W HENRIETTA RD
Second Line	:	SUITE 1
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-9596
Country	:	US
Telephone Number	:	585-889-3510
Fax Number	:	585-334-5833

Provider Business Practice Location Address
First Line	:	201 SCOTTSVILLE W HENRIETTA RD
Second Line	:
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-9596
Country	:	US
Telephone Number	:	585-889-3510
Fax Number	:	585-334-5833

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL WELSCH
Credential	:
Telephone Number	:	585-889-3510

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	06/08/2016

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Directions to “OLDE CANAL PHARMACY INC ” Practice Location

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