Provider Demographics
NPI:1043232283
Name:GEROULD'S PROFESSIONAL PHARMACY INC.
Entity Type:Organization
Organization Name:GEROULD'S PROFESSIONAL PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:607-732-0597
Mailing Address - Street 1:PO BOX 4067
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-0067
Mailing Address - Country:US
Mailing Address - Phone:607-732-0597
Mailing Address - Fax:607-733-7911
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-1311
Practice Address - Country:US
Practice Address - Phone:607-732-0597
Practice Address - Fax:607-733-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00358801Medicaid
NY00358801Medicaid