Healthcare Provider Details

I. General information

NPI: 1689691578
Provider Name (Legal Business Name): PEEKSKILL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MAIN ST
PEEKSKILL NY
10566-2904
US

IV. Provider business mailing address

950 MAIN ST
PEEKSKILL NY
10566-2904
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-3076
  • Fax: 914-737-4229
Mailing address:
  • Phone: 914-737-3076
  • Fax: 914-737-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number017490
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number017490
License Number StateNY

VIII. Authorized Official

Name: MR. JESUS VAZQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 914-737-3076