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General NPI Number Information
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NPI Number | 1053414532
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Entity Type | Organization
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Legal Business Name | CRYSTAL RUN PHARMACY LLC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 731 ROUTE 211 E STE 108
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City | MIDDLETOWN
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State | NY
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Zip | 10941-1457
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Country | US
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Telephone | 845-692-7628
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Fax | 845-692-7644
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Provider Business Mailing Address
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Address Line | 731 ROUTE 211 E STE 108
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City | MIDDLETOWN
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State | NY
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Zip | 10941-1457
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Country | US
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Telephone | 845-692-7628
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Fax | 845-692-7644
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | SANDRA AGNELLO
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Credential |
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Telephone | 845-863-6750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 027541
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License Number State | NY
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