Provider Demographics
NPI:1467521799
Name:COTTRILLS PHARMACY INC
Entity Type:Organization
Organization Name:COTTRILLS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OBROCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-508-8481
Mailing Address - Street 1:255 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1214
Mailing Address - Country:US
Mailing Address - Phone:585-492-2310
Mailing Address - Fax:585-492-2310
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1214
Practice Address - Country:US
Practice Address - Phone:585-492-2310
Practice Address - Fax:585-492-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011114251E00000X, 3336C0003X, 3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251E00000XAgenciesHome Health
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201398270AMedicaid
NM45107301Medicaid
NY00596570Medicaid
PA1027458620001Medicaid
MD079044300Medicaid
AZ232725Medicaid
OH0093115Medicaid
UT3001456Medicaid