Provider Demographics
NPI:1346284197
Name:GEROULDS PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:GEROULDS PROFESSIONAL PHARMACY INC
Other - Org Name:GEROULD'S PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:607-936-3233
Mailing Address - Street 1:98 W PULTENEY ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 W PULTENEY ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2260
Practice Address - Country:US
Practice Address - Phone:607-936-3233
Practice Address - Fax:607-936-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0262623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3334707OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02472315NYMedicaid
0418100003Medicare NSC