Provider Demographics
NPI:1396859245
Name:MARGARETVILLE HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:MARGARETVILLE HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:845-586-2631
Mailing Address - Street 1:42084 STATE HIGHWAY 28
Mailing Address - Street 2:ROUTE 28
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455-2820
Mailing Address - Country:US
Mailing Address - Phone:845-586-2631
Mailing Address - Fax:845-586-1786
Practice Address - Street 1:42084 STATE HIGHWAY 28
Practice Address - Street 2:ROUTE 28
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455-2820
Practice Address - Country:US
Practice Address - Phone:845-586-2631
Practice Address - Fax:845-586-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279387Medicare ID - Type Unspecified