Healthcare Provider Details

I. General information

NPI: 1104399609
Provider Name (Legal Business Name): MCCANN DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MAIN ST
HUDSON FALLS NY
12839-1846
US

IV. Provider business mailing address

166 MAIN ST
HUDSON FALLS NY
12839-1846
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-4732
  • Fax: 518-747-6667
Mailing address:
  • Phone: 518-747-4732
  • Fax: 518-747-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON R MCCANN
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 518-747-4732