Healthcare Provider Details

I. General information

NPI: 1073965729
Provider Name (Legal Business Name): PROPEL PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 02/15/2022
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 STATE ROUTE 31 STE 4
CICERO NY
13039-7857
US

IV. Provider business mailing address

5962 STATE ROUTE 31 STE 4
CICERO NY
13039-7857
US

V. Phone/Fax

Practice location:
  • Phone: 888-407-8015
  • Fax: 866-277-1796
Mailing address:
  • Phone: 888-407-8015
  • Fax: 866-277-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034875
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERICA RACHELLE DURANT
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 888-407-8015