Provider Demographics
NPI:1043762875
Name:ERIE CANAL LLC
Entity Type:Organization
Organization Name:ERIE CANAL LLC
Other - Org Name:ERIE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-486-4807
Mailing Address - Street 1:60 FINN ROAD SUITE B
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467
Mailing Address - Country:US
Mailing Address - Phone:585-486-4807
Mailing Address - Fax:585-444-9224
Practice Address - Street 1:60 FINN RD STE B
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9393
Practice Address - Country:US
Practice Address - Phone:585-486-4807
Practice Address - Fax:585-444-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0349503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy