=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568865897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY FOR THE PUBLIC GOOD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2014
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 MAIN ST
-----------------------------------------------------
City | PHOENICIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-688-0188
-----------------------------------------------------
Fax | 845-688-3378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 211
-----------------------------------------------------
City | PHOENICIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12464-0211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDWARD A ULLMANN
-----------------------------------------------------
Credential | R. PH
-----------------------------------------------------
Telephone | 845-688-0188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------