Provider Demographics
NPI:1497230023
Name:CONGERS PHARMACY INC
Entity Type:Organization
Organization Name:CONGERS PHARMACY INC
Other - Org Name:COMMUNITY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SRUTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPHI
Authorized Official - Phone:845-267-5945
Mailing Address - Street 1:15 S ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2449
Mailing Address - Country:US
Mailing Address - Phone:845-267-5945
Mailing Address - Fax:845-267-4885
Practice Address - Street 1:15 S ROUTE 303
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2449
Practice Address - Country:US
Practice Address - Phone:845-267-5945
Practice Address - Fax:845-267-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036085OtherSTATE BOARD OF PHARMACY