Provider Demographics
NPI:1134279888
Name:BOICEVILLE PHARMACY INC
Entity Type:Organization
Organization Name:BOICEVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:NEKOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-657-6511
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:BOICEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12412-0474
Mailing Address - Country:US
Mailing Address - Phone:845-657-6511
Mailing Address - Fax:845-657-9854
Practice Address - Street 1:4103 RT 28
Practice Address - Street 2:
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412
Practice Address - Country:US
Practice Address - Phone:845-657-6511
Practice Address - Fax:845-657-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01294031Medicaid
NY3880900001Medicare NSC