Provider Demographics
NPI:1366490260
Name:CARE CENTER PHARMACY
Entity Type:Organization
Organization Name:CARE CENTER PHARMACY
Other - Org Name:CARE CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-336-1616
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-0552
Mailing Address - Country:US
Mailing Address - Phone:716-366-0986
Mailing Address - Fax:716-366-0777
Practice Address - Street 1:17 W LUCAS AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-3320
Practice Address - Country:US
Practice Address - Phone:716-366-0986
Practice Address - Fax:716-366-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0245293336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3313359OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY01080120Medicaid
NY01080120Medicaid