Healthcare Provider Details

I. General information

NPI: 1225376098
Provider Name (Legal Business Name): WOODMARK PHARMACY OF NEW YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 WEHRLE DR
WILLIAMSVILLE NY
14221-7748
US

IV. Provider business mailing address

641 LEXINGTON AVE 31ST FLOOR
NEW YORK NY
10022-4503
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-3381
  • Fax:
Mailing address:
  • Phone: 212-802-7609
  • Fax: 646-924-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031869
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number031869
License Number StateNY

VIII. Authorized Official

Name: MR. SCOTT KRUSE
Title or Position: DIRECTOR
Credential: RPH
Phone: 716-260-6936