Healthcare Provider Details

I. General information

NPI: 1396859245
Provider Name (Legal Business Name): MARGARETVILLE HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42084 STATE HIGHWAY 28 ROUTE 28
MARGARETVILLE NY
12455-2820
US

IV. Provider business mailing address

42084 STATE HIGHWAY 28 ROUTE 28
MARGARETVILLE NY
12455-2820
US

V. Phone/Fax

Practice location:
  • Phone: 845-586-2631
  • Fax: 845-586-1786
Mailing address:
  • Phone: 845-586-2631
  • Fax: 845-586-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL N MOORE
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMACIST
Phone: 845-586-2631