Provider Demographics
NPI:1073532008
Name:STATE OF NEW YORK
Entity Type:Organization
Organization Name:STATE OF NEW YORK
Other - Org Name:ATTICA CORRECTIONAL FACILITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GHISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-591-2000
Mailing Address - Street 1:EXCHANGE ST RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1211
Mailing Address - Country:US
Mailing Address - Phone:585-591-2000
Mailing Address - Fax:585-591-2000
Practice Address - Street 1:EXCHANGE ST RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1211
Practice Address - Country:US
Practice Address - Phone:585-591-2000
Practice Address - Fax:585-591-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0064673336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2062686OtherPK