Healthcare Provider Details

I. General information

NPI: 1477929529
Provider Name (Legal Business Name): MEDWIZ PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N MAIN ST
SPRING VALLEY NY
10977-4020
US

IV. Provider business mailing address

240 N MAIN ST
SPRING VALLEY NY
10977-4020
US

V. Phone/Fax

Practice location:
  • Phone: 845-624-5200
  • Fax: 845-624-5300
Mailing address:
  • Phone: 845-624-5200
  • Fax: 845-624-5300

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 Number029312
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC NEWHOUSE
Title or Position: CEO,OWNER,AO
Credential:
Phone: 845-558-5390