MEDICARE: VINCE'S PHARMACY OF CAMILLUS 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0719740001	OTHER	NY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018681	OTHER	NY	NYS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962129247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCE'S PHARMACY OF CAMILLUS INC

Provider Business Mailing Address
First Line	:	240 TOWNSHIP BLVD STE 30
Second Line	:
City	:	CAMILLUS
State	:	NY
Zip	:	13031-1793
Country	:	US
Telephone Number	:	315-487-5775
Fax Number	:	315-487-4423

Provider Business Practice Location Address
First Line	:	240 TOWNSHIP BLVD STE 30
Second Line	:
City	:	CAMILLUS
State	:	NY
Zip	:	13031-1793
Country	:	US
Telephone Number	:	315-487-5775
Fax Number	:	315-487-4423

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL MACHEN
Credential	:	PHARMD
Telephone Number	:	315-487-5775

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	03/07/2023

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Directions to “VINCE'S PHARMACY OF CAMILLUS INC ” Practice Location

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