Healthcare Provider Details

I. General information

NPI: 1285746297
Provider Name (Legal Business Name): ALFRED PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N MAIN ST
ALFRED NY
14802-1011
US

IV. Provider business mailing address

36 N MAIN ST
ALFRED NY
14802-1011
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-9222
  • Fax: 607-587-9629
Mailing address:
  • Phone: 607-587-9222
  • Fax: 607-587-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number019532
License Number StateNY

VIII. Authorized Official

Name: ANTHONY GRAZIANO
Title or Position: OWNER
Credential: RPH
Phone: 607-587-9222