Healthcare Provider Details

I. General information

NPI: 1164633558
Provider Name (Legal Business Name): BROADALBIN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N MAIN ST
BROADALBIN NY
12025
US

IV. Provider business mailing address

PO BOX 249
BROADALBIN NY
12025-0249
US

V. Phone/Fax

Practice location:
  • Phone: 518-883-8333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020051
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL B JULIUS
Title or Position: PRESIDENT
Credential:
Phone: 518-883-3333