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NPI Code Detail

MEDICARE: NYACK APOTHECARY INC

MEDICARE: NYACK APOTHECARY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy032294NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12144105OTHERPK

General Provider Information

NPI Number : 1114367653
Entity Type Code : Organization
Provider Name (Legal Business Name) : NYACK APOTHECARY INC
Provider Business Mailing Address
First Line : 96 MAIN ST
Second Line :
City : NYACK
State : NY
Zip : 10960-3110
Country : US
Telephone Number : 845-358-0688
Fax Number : 914-358-7966
Provider Business Practice Location Address
First Line : 96 MAIN ST
Second Line :
City : NYACK
State : NY
Zip : 10960-3110
Country : US
Telephone Number : 845-358-0688
Fax Number : 914-358-7966
Authorized Official
Title or Position : PRESIDENT
Name : JEFFREY RUCKER
Credential :
Telephone Number : 845-358-0688
Provider Enumeration Date : 06/28/2013
Last Update Date : 06/24/2014

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