=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487194874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COTTRILLS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2017
-----------------------------------------------------
Last Update Date | 06/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4919 ELLICOTT RD
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-508-8481
-----------------------------------------------------
Fax | 716-508-8482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4919 ELLICOTT RD
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-508-8481
-----------------------------------------------------
Fax | 716-508-8482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF CLINICAL OFFICER/SVP
-----------------------------------------------------
Name | ERIN E. MELLERSKI
-----------------------------------------------------
Credential | PHARMD, CSP
-----------------------------------------------------
Telephone | 716-508-8481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------