Provider Demographics
NPI:1073965729
Name:PROPEL PHARMACY, LLC
Entity Type:Organization
Organization Name:PROPEL PHARMACY, LLC
Other - Org Name:PROPEL PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:888-407-8015
Mailing Address - Street 1:5962 STATE ROUTE 31 STE 4
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-7857
Mailing Address - Country:US
Mailing Address - Phone:888-407-8015
Mailing Address - Fax:866-277-1796
Practice Address - Street 1:5962 STATE ROUTE 31 STE 4
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-7857
Practice Address - Country:US
Practice Address - Phone:888-407-8015
Practice Address - Fax:866-277-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034875333600000X
3336C0003X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162085OtherPK