Provider Demographics
NPI:1164566154
Name:CATHMIN CORP
Entity Type:Organization
Organization Name:CATHMIN CORP
Other - Org Name:BLOOMING GROVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-782-2260
Mailing Address - Street 1:1200 STATE ROUTE 208
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4648
Mailing Address - Country:US
Mailing Address - Phone:845-782-2260
Mailing Address - Fax:
Practice Address - Street 1:1200 STATE ROUTE 208
Practice Address - Street 2:SUITE #1
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4648
Practice Address - Country:US
Practice Address - Phone:845-782-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0205553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01172141Medicaid
NY33-95868OtherNCDPD
NY33-95868OtherNCDPD