Healthcare Provider Details

I. General information

NPI: 1184835969
Provider Name (Legal Business Name): PHARMACY OPERATIONS OF NEW YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 STATE ROUTE 17C
OWEGO NY
13827-4819
US

IV. Provider business mailing address

1 RIDER TRAIL PLAZA DRIVE SUITE 300
EARTH CITY MO
63045-1313
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028520
License Number StateNY

VIII. Authorized Official

Name: DENA FERMAN
Title or Position: THIRD PARTY PLAN COORDINATOR
Credential:
Phone: 314-993-6000