Provider Demographics
NPI:1598475634
Name:PHARMACY FOR THE PUBLIC GOOD, INC.
Entity type:Organization
Organization Name:PHARMACY FOR THE PUBLIC GOOD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST / MANAGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ULLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-688-0188
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:PHOENICIA
Mailing Address - State:NY
Mailing Address - Zip Code:12464-0211
Mailing Address - Country:US
Mailing Address - Phone:845-688-0188
Mailing Address - Fax:845-688-3378
Practice Address - Street 1:53 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PHOENICIA
Practice Address - State:NY
Practice Address - Zip Code:12464-1246
Practice Address - Country:US
Practice Address - Phone:845-688-0188
Practice Address - Fax:845-688-3378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY FOR THE PUBLIC GOOD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07731166Medicaid