Healthcare Provider Details

I. General information

NPI: 1225035538
Provider Name (Legal Business Name): DEDRICK'S PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 N FRONT ST
KINGSTON NY
12401-3832
US

IV. Provider business mailing address

86 N FRONT ST
KINGSTON NY
12401-3832
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-8000
  • Fax: 845-338-5128
Mailing address:
  • Phone: 845-338-8000
  • Fax: 845-338-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number011044
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE S NEKOS
Title or Position: OWNER
Credential: R.PH.
Phone: 845-338-8000