Healthcare Provider Details

I. General information

NPI: 1831464684
Provider Name (Legal Business Name): PARK PHARMACY OF HAMMONDSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SHETHAR ST
HAMMONDSPORT NY
14840-9380
US

IV. Provider business mailing address

27 SHETHAR ST PO BOX 188
HAMMONDSPORT NY
14840-9380
US

V. Phone/Fax

Practice location:
  • Phone: 607-569-2800
  • Fax: 607-569-3250
Mailing address:
  • Phone: 607-569-2800
  • Fax: 607-569-3250

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 Number031160
License Number StateNY

VIII. Authorized Official

Name: SHELLY DAY
Title or Position: MEMBER
Credential:
Phone: 607-569-2800