Healthcare Provider Details

I. General information

NPI: 1821127820
Provider Name (Legal Business Name): AVERYS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10504 MAIN ST
NORTH COLLINS NY
14111-0579
US

IV. Provider business mailing address

10504 MAIN ST PO BOX 579
NORTH COLLINS NY
14111-0579
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-2992
  • Fax: 716-337-3090
Mailing address:
  • Phone: 716-337-2992
  • Fax: 716-337-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number016608
License Number StateNY

VIII. Authorized Official

Name: MR. A FRANK MAURO
Title or Position: OWNER
Credential: RPH
Phone: 716-337-2992