Healthcare Provider Details

I. General information

NPI: 1386280931
Provider Name (Legal Business Name): CONDO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MONTCALM AVE
PLATTSBURGH NY
12901-1533
US

IV. Provider business mailing address

28 MONTCALM AVE
PLATTSBURGH NY
12901-1533
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-3400
  • Fax: 518-563-5946
Mailing address:
  • Phone: 518-563-3400
  • Fax: 518-563-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN F MOORE
Title or Position: VP
Credential: PHARMD
Phone: 518-563-3400