Provider Demographics
NPI:1265909691
Name:BARTHS OF JAMESPORT INC
Entity type:Organization
Organization Name:BARTHS OF JAMESPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:CASSARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-722-3900
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:JAMESPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11947-0667
Mailing Address - Country:US
Mailing Address - Phone:631-722-3900
Mailing Address - Fax:631-722-3999
Practice Address - Street 1:1491 MAIN RD
Practice Address - Street 2:
Practice Address - City:JAMESPORT
Practice Address - State:NY
Practice Address - Zip Code:11947
Practice Address - Country:US
Practice Address - Phone:631-722-3900
Practice Address - Fax:631-722-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05021807Medicaid