Provider Demographics
NPI:1063504215
Name:SPRINGCREEK PHARMACY
Entity Type:Organization
Organization Name:SPRINGCREEK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIILIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-592-9065
Mailing Address - Street 1:227 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1017
Mailing Address - Country:US
Mailing Address - Phone:716-592-9065
Mailing Address - Fax:716-592-9064
Practice Address - Street 1:227 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1017
Practice Address - Country:US
Practice Address - Phone:716-592-9065
Practice Address - Fax:716-592-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038947-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8210881OtherIHA
NY10178460OtherFIDELIS
NY00030176701OtherUNIVERA
NY005513171OtherBCBS
NY01973968Medicaid
NY1281060001Medicare NSC