Provider Demographics
NPI:1073699849
Name:OMNICARE OF NEW YORK, LLC
Entity Type:Organization
Organization Name:OMNICARE OF NEW YORK, LLC
Other - Org Name:OMNICARE OF BISHOP GADSDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:201 E 4TH ST
Mailing Address - Street 2:900 OMNICARE CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-4248
Mailing Address - Country:US
Mailing Address - Phone:513-719-2600
Mailing Address - Fax:
Practice Address - Street 1:1 BISHOP GADSDEN WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3506
Practice Address - Country:US
Practice Address - Phone:843-406-0902
Practice Address - Fax:843-406-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-008477332BP3500X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
4224767OtherNCPDP
4224767OtherNCPDP