Healthcare Provider Details

I. General information

NPI: 1740647189
Provider Name (Legal Business Name): SAUGERTIES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 06/30/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MARKET ST
SAUGERTIES NY
12477-1339
US

IV. Provider business mailing address

18 MARKET ST
SAUGERTIES NY
12477-1339
US

V. Phone/Fax

Practice location:
  • Phone: 845-246-5649
  • Fax:
Mailing address:
  • Phone: 845-246-5649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034385
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER NEKOS
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 845-246-5649