Healthcare Provider Details

I. General information

NPI: 1669755666
Provider Name (Legal Business Name): HARBOR PHARMACY OF UTICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 JAMES ST STE B1
SYRACUSE NY
13203-2500
US

IV. Provider business mailing address

24 W BRIDGE ST
OSWEGO NY
13126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-6822
  • Fax: 315-342-5951
Mailing address:
  • Phone: 315-735-3300
  • Fax: 315-342-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number031033
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES BRANSHAW
Title or Position: MEMBER
Credential:
Phone: 315-342-6822