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General NPI Number Information
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NPI Number | 1689296733
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Entity Type | Organization
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Legal Business Name | ELLICOTTVILLE PHARMACY INC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 6133 ROUTE 219 S STE 1004
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City | ELLICOTTVILLE
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State | NY
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Zip | 14731-9613
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Country | US
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Telephone | 716-699-2384
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Fax |
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Provider Business Mailing Address
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Address Line | 6133 ROUTE 219 S STE 1004
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City | ELLICOTTVILLE
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State | NY
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Zip | 14731-9613
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Country | US
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Telephone | 716-699-2384
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BENJAMIN GILROY
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Credential | RPH
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Telephone | 716-699-2384
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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