COTTRILLS PHARMACY INC

Provider Demographics

• NPI: 1487194874
• Name: COTTRILLS PHARMACY INC
• Entity Type: Organization
• Organization Name: COTTRILLS PHARMACY INC
• Other - Org Name: COTTRILLS PHARMACY, INC.
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CHIEF CLINICAL OFFICER/SVP
• Authorized Official - First Name: ERIN
• Authorized Official - Middle Name: E
• Authorized Official - Last Name: MELLERSKI
• Authorized Official - Credentials: PHARMD, CSP
• Authorized Official - Phone: 716-508-8481
• Mailing Address - Street 1: 4919 ELLICOTT RD
• Mailing Address - City: ORCHARD PARK
• Mailing Address - State: NY
• Mailing Address - Zip Code: 14127-3357
• Mailing Address - Country: US
• Mailing Address - Phone: 716-508-8481
• Mailing Address - Fax: 716-508-8482
• Practice Address - Street 1: 4919 ELLICOTT RD
• Practice Address - City: ORCHARD PARK
• Practice Address - State: NY
• Practice Address - Zip Code: 14127-3357
• Practice Address - Country: US
• Practice Address - Phone: 716-508-8481
• Practice Address - Fax: 716-508-8482
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2017-03-03
• Last Update Date: 2023-06-06

Provider Licenses

State	License ID	Taxonomies
		3336C0003X, 3336H0001X, 3336S0011X
GA	PHNR000745	3336S0011X
FL	PH29246	3336S0011X
MI	530101183	3336S0011X
KS	22-44932	3336S0011X
HI	PMP-1206	3336S0011X
IN	64001852A	3336S0011X
KY	NY2037	3336S0011X
ID	45864MS	3336S0011X
MS	14698/7.1	3336S0011X
MN	264818	3336S0011X
LA	PHY.007493-NR	3336S0011X
AK	122787	3336S0011X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MD	0790443 01	Medicaid
OH	0226826	Medicaid
PA	1027458620002	Medicaid
AZ	320287	Medicaid
NY	04789873	Medicaid
KY	7100436300	Medicaid
IL	1487194874	Medicaid
DE	250428333	Medicaid
MT	1487194874	Medicaid
MI	1487194874	Medicaid
	2168227	Other	PK