Provider Demographics
NPI:1437683406
Name:EMPIRE STATE PHARMACY LLC
Entity Type:Organization
Organization Name:EMPIRE STATE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATERNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-356-3779
Mailing Address - Street 1:155 ROUTE 202 # STORE1
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-1626
Mailing Address - Country:US
Mailing Address - Phone:844-356-3779
Mailing Address - Fax:844-357-3779
Practice Address - Street 1:155 ROUTE 202 # STORE1
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-1626
Practice Address - Country:US
Practice Address - Phone:844-356-3779
Practice Address - Fax:844-357-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy