MEDICARE: SUNY HEALTH SCIENCE CENTER AT SYRACUSE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0002X	Clinic Pharmacy
4	3336S0011X	Specialty Pharmacy
5	3336M0002X	Mail Order Pharmacy
6	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2174989	OTHER		PK

General Provider Information

NPI Number	:	1396330932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNY HEALTH SCIENCE CENTER AT SYRACUSE

Provider Business Mailing Address
First Line	:	750 E ADAMS ST
Second Line	:	ATTN: OUTPATIENT PHARMACY
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2306
Country	:	US
Telephone Number	:	315-464-3784
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 W SENECA TPKE STE A
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-2279
Country	:	US
Telephone Number	:	315-464-3784
Fax Number	:	315-464-4221

Authorized Official
Title or Position	:	CFO
Name	:	STUART WRIGHT
Credential	:
Telephone Number	:	315-464-5179

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/05/2021

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