Healthcare Provider Details

I. General information

NPI: 1659882298
Provider Name (Legal Business Name): MIDDLEBURGH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MARKET ST
MIDDLEBURGH NY
12122-6432
US

IV. Provider business mailing address

45 ZERNER BLVD
HOPEWELL JUNCTION NY
12533-5110
US

V. Phone/Fax

Practice location:
  • Phone: 518-827-7030
  • Fax: 518-827-7032
Mailing address:
  • Phone: 845-380-0951
  • Fax: 845-380-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035912
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER CAMPORESE
Title or Position: PRESIDENT
Credential:
Phone: 845-380-0951