Healthcare Provider Details

I. General information

NPI: 1285657452
Provider Name (Legal Business Name): DOUGHERTY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E MAIN ST BOX 237
MORRISVILLE NY
13408
US

IV. Provider business mailing address

14 E MAIN ST BOX 237
MORRISVILLE NY
13408
US

V. Phone/Fax

Practice location:
  • Phone: 315-684-3171
  • Fax:
Mailing address:
  • Phone: 315-684-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022390
License Number StateNY

VIII. Authorized Official

Name: JENNIFER CALOIA
Title or Position: PRESIDENT
Credential:
Phone: 315-684-3171