Healthcare Provider Details

I. General information

NPI: 1851484166
Provider Name (Legal Business Name): NUNDA FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N STATE ST
NUNDA NY
14517-0518
US

IV. Provider business mailing address

PO BOX 518
NUNDA NY
14517-0518
US

V. Phone/Fax

Practice location:
  • Phone: 585-468-2416
  • Fax: 585-468-5705
Mailing address:
  • Phone: 585-468-2416
  • Fax: 585-468-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027179
License Number StateNY

VIII. Authorized Official

Name: JEREMIAH AXTELL
Title or Position: OWNER
Credential: RPH
Phone: 585-468-2416