MEDICARE: NUNDA FAMILY PHARMACY LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	027179	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
2	2063750	OTHER		PK

General Provider Information

NPI Number	:	1851484166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUNDA FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 518
Second Line	:
City	:	NUNDA
State	:	NY
Zip	:	14517-0518
Country	:	US
Telephone Number	:	585-468-2416
Fax Number	:	585-468-5705

Provider Business Practice Location Address
First Line	:	12 N STATE ST
Second Line	:
City	:	NUNDA
State	:	NY
Zip	:	14517-0518
Country	:	US
Telephone Number	:	585-468-2416
Fax Number	:	585-468-5705

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMIAH AXTELL
Credential	:	RPH
Telephone Number	:	585-468-2416

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/11/2017

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1265502942 — MR. JEREMIAH S AXTELL RPH
Practice Location Address:

12 STATE ST
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14517-0518

Practice Phone: 585-468-2416
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1609854264 — DR. DONALD ROBERT WILCOX DC DABCO
Practice Location Address:

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1639137904 — DONNA SAYADOFF-FLAHERTY PA-C
Practice Location Address:

61 STATE STREET
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14517-9785

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1063460061 — DR. NORMAN WETTERAU MD
Practice Location Address:

61 STATE ST
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1548203516 — GERALD E. TURK NPP-C
Practice Location Address:

9077 STATE ROUTE 408
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1871640821 — DALTON-NUNDA CENTRAL SCHOOL DISTRICT
Practice Location Address:

15 MILL STREET
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Directions to “NUNDA FAMILY PHARMACY LLC ” Practice Location

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