Healthcare Provider Details

I. General information

NPI: 1851322937
Provider Name (Legal Business Name): KINNEY DRUGS, INC. #88
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EAST MAIN STREET
MARATHON NY
13803-0284
US

IV. Provider business mailing address

PO BOX 284
MARATHON NY
13803-0284
US

V. Phone/Fax

Practice location:
  • Phone: 607-849-6156
  • Fax: 607-849-6111
Mailing address:
  • Phone: 607-849-6156
  • Fax: 607-849-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027833
License Number StateNY

VIII. Authorized Official

Name: JENNIFER M JONES
Title or Position: THIRD PARTY COORDINATOR
Credential:
Phone: 315-287-3600