Healthcare Provider Details

I. General information

NPI: 1275981102
Provider Name (Legal Business Name): CORDANT PHARMACY NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 PARK AVE
HUNTINGTON NY
11743-3912
US

IV. Provider business mailing address

12015 E 46TH AVE SUITE 220
DENVER CO
80239-3116
US

V. Phone/Fax

Practice location:
  • Phone: 516-806-5943
  • Fax: 631-683-4940
Mailing address:
  • Phone: 855-895-8090
  • Fax: 303-371-0583

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 Number035002
License Number StateNY

VIII. Authorized Official

Name: BETSY ARDITA
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 303-749-0490