Healthcare Provider Details

I. General information

NPI: 1568569408
Provider Name (Legal Business Name): NEWARK VILLAGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MILLER ST
NEWARK NY
14513-1422
US

IV. Provider business mailing address

105 W MILLER ST
NEWARK NY
14513-1422
US

V. Phone/Fax

Practice location:
  • Phone: 315-331-9999
  • Fax: 315-331-9958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number026257
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DARREN PYNN
Title or Position: OWNER
Credential: RPH
Phone: 315-331-9999