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General NPI Number Information
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NPI Number | 1700025665
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Entity Type | Organization
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Legal Business Name | MEDWIZ SPECIALTY, LLC
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 167 ROUTE 304 SUITE 201
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City | BARDONIA
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State | NY
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Zip | 10954-2050
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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 | 167 ROUTE 304 SUITE 201
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City | BARDONIA
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State | NY
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Zip | 10954-2050
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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 | MR. ERIC E. 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 | 3336H0001X
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Taxonomy Name | Home Infusion Therapy 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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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