Provider Demographics
NPI:1497818538
Name:THE CARE CENTER PHRMACY, INC.
Entity Type:Organization
Organization Name:THE CARE CENTER PHRMACY, INC.
Other - Org Name:GOWANDA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-366-1616
Mailing Address - Street 1:41 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1305
Mailing Address - Country:US
Mailing Address - Phone:716-532-8000
Mailing Address - Fax:716-532-5191
Practice Address - Street 1:41 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1305
Practice Address - Country:US
Practice Address - Phone:716-532-8000
Practice Address - Fax:716-532-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0198483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02773724Medicaid
NY3327889OtherNCPDP
NY3327889OtherNCPDP