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General NPI Number Information
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NPI Number | 1225035538
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Entity Type | Organization
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Legal Business Name | DEDRICK'S PHARMACY INC.
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 86 N FRONT ST
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City | KINGSTON
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State | NY
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Zip | 12401-3832
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Country | US
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Telephone | 845-338-8000
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Fax | 845-338-5128
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Provider Business Mailing Address
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Address Line | 86 N FRONT ST
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City | KINGSTON
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State | NY
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Zip | 12401-3832
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Country | US
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Telephone | 845-338-8000
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Fax | 845-338-5128
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE S NEKOS
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Credential | R.PH.
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Telephone | 845-338-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 011044
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License Number State | NY
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