Provider Demographics
NPI:1508885773
Name:WILLIAM C. IRWIN
Entity Type:Organization
Organization Name:WILLIAM C. IRWIN
Other - Org Name:MOLLOY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH,
Authorized Official - Phone:845-229-8881
Mailing Address - Street 1:4170 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1762
Mailing Address - Country:US
Mailing Address - Phone:845-229-8881
Mailing Address - Fax:
Practice Address - Street 1:4170 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1762
Practice Address - Country:US
Practice Address - Phone:845-229-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021141333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01267165Medicaid
NY0405270001Medicare NSC