Healthcare Provider Details

I. General information

NPI: 1982438818
Provider Name (Legal Business Name): CMV PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MAIN ST
ADDISON NY
14801-1210
US

IV. Provider business mailing address

36 MAIN ST
ADDISON NY
14801-1210
US

V. Phone/Fax

Practice location:
  • Phone: 607-695-1600
  • Fax:
Mailing address:
  • Phone: 607-695-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: COLIN VALENTA
Title or Position: PRESIDENT
Credential:
Phone: 607-323-1303