Provider Demographics
NPI:1871590182
Name:NEW PALTZ PHARMACY INC
Entity type:Organization
Organization Name:NEW PALTZ PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NEKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-255-0310
Mailing Address - Street 1:190 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1211
Mailing Address - Country:US
Mailing Address - Phone:845-255-0310
Mailing Address - Fax:845-255-0576
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561
Practice Address - Country:US
Practice Address - Phone:845-255-0310
Practice Address - Fax:845-255-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0147113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2061616OtherPK
NY00266775Medicaid
0140010001Medicare NSC