MEDICARE: PINE PLAINS PHARMACY 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
1	183500000X	Pharmacist	019013	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770514473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE PLAINS PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	PINE PLAINS
State	:	NY
Zip	:	12567-0339
Country	:	US
Telephone Number	:	518-398-5588
Fax Number	:	518-398-7588

Provider Business Practice Location Address
First Line	:	2965 CHURCH ST
Second Line	:
City	:	PINE PLAINS
State	:	NY
Zip	:	12567-0339
Country	:	US
Telephone Number	:	518-398-5588
Fax Number	:	518-398-7588

Authorized Official
Title or Position	:	PRES
Name	:	NASIR MAHMOOD
Credential	:	RPH
Telephone Number	:	518-398-5588

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/06/2024

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Directions to “PINE PLAINS PHARMACY INC ” Practice Location

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