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General NPI Number Information
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NPI Number | 1093239337
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Entity Type | Organization
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Legal Business Name | MEDWIZ PHARMACY LLC
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 240 N MAIN ST
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City | SPRING VALLEY
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State | NY
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Zip | 10977-4020
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Country | US
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Telephone | 845-624-5200
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Fax | 845-624-5300
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Provider Business Mailing Address
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Address Line | 240 N MAIN ST
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City | SPRING VALLEY
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State | NY
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Zip | 10977-4020
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Country | US
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Telephone | 845-624-5200
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Fax | 845-624-5300
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Authorized Official
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Title or Position | CEO
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Name | ERIC NEWHOUSE
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Credential |
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Telephone | 845-624-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RO00140500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 029312
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH30176
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License Number State | FL
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