Provider Demographics
NPI:1083660385
Name:DENNIS K ZINK & CLAIR C INKLEY PTR
Entity Type:Organization
Organization Name:DENNIS K ZINK & CLAIR C INKLEY PTR
Other - Org Name:INKLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:INKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-358-3201
Mailing Address - Street 1:113 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-1131
Mailing Address - Country:US
Mailing Address - Phone:716-358-3201
Mailing Address - Fax:716-358-2546
Practice Address - Street 1:113 MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-1131
Practice Address - Country:US
Practice Address - Phone:716-358-3201
Practice Address - Fax:716-358-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0150353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00614613Medicaid
2063647OtherPK
0571590001Medicare NSC