Healthcare Provider Details

I. General information

NPI: 1922461540
Provider Name (Legal Business Name): KATONAH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 KATONAH AVE
KATONAH NY
10536-2110
US

IV. Provider business mailing address

202 KATONAH AVE
KATONAH NY
10536-2110
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-2300
  • Fax: 914-232-1130
Mailing address:
  • Phone: 914-232-2300
  • Fax: 914-232-1130

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 Number034634
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS RYDER
Title or Position: VP, MANAGER,AO
Credential:
Phone: 914-232-2300