Healthcare Provider Details

I. General information

NPI: 1558433342
Provider Name (Legal Business Name): TLK OF CORTLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 STATE ROUTE 222
CORTLAND NY
13045-1844
US

IV. Provider business mailing address

1099 STATE ROUTE 222
CORTLAND NY
13045-1844
US

V. Phone/Fax

Practice location:
  • Phone: 607-756-4563
  • Fax: 607-753-0896
Mailing address:
  • Phone: 607-756-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number30302
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK ROBERTS
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 607-756-4563