MEDICARE: PORT EWEN RX 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
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	032682	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2147379	OTHER		PK

General Provider Information

NPI Number	:	1821426321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT EWEN RX INC

Provider Business Mailing Address
First Line	:	PO BOX 759
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-0759
Country	:	US
Telephone Number	:	845-331-4229
Fax Number	:	845-340-4593

Provider Business Practice Location Address
First Line	:	177 BROADWAY
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-7719
Country	:	US
Telephone Number	:	845-331-4229
Fax Number	:	845-340-4593

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. VINAY ADUSUMILLI
Credential	:
Telephone Number	:	440-281-2324

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	12/22/2020

Similar Medicare Providers

1174470751 — ELIZABETH ANNE STANZIONE
Practice Location Address:

177 BROADWAY
PORT EWEN, NY
12466-7719

Practice Phone: 845-339-4129
Practice Fax:

1548322308 — PORT EWEN PHARMACY INC
Practice Location Address:

177 BROADWAY
PORT EWEN, NY
12466-7719

Practice Phone: 845-331-4229
Practice Fax: 845-340-4593

1225091077 — DR. ROBERT PATRICK MARTINI JR. D.C.
Practice Location Address:

1243 SKYTOP MOUNTAIN RD , SUITE1
PORT MATILDA, PA
16870-7719

Practice Phone: 814-238-6300
Practice Fax: 814-238-0976

1730132671 — ROBERT P. MARTINI JR, D.C.
Practice Location Address:

1243 SKYTOP MOUNTAIN RD , SUITE1
PORT MATILDA, PA
16870-7719

Practice Phone: 814-238-6300
Practice Fax: 814-238-0976

1659644565 — DR. LINDSEY DEANN PRICE D.D.S.
Practice Location Address:

4700 HIGHWAY 365 STE F
PORT ARTHUR, TX
77642-7719

Practice Phone: 409-721-6300
Practice Fax: 409-721-6303

1114673019 — SEALE TX4 INC.
Practice Location Address:

4700 HIGHWAY 365 STE F
PORT ARTHUR, TX
77642-7719

Practice Phone: 409-721-6300
Practice Fax:

Directions to “PORT EWEN RX INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.