Provider Demographics
NPI:1518041656
Name:ELSMERE PHARMACY INC
Entity Type:Organization
Organization Name:ELSMERE PHARMACY INC
Other - Org Name:CHAZAN PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-462-0612
Mailing Address - Street 1:31 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3527
Mailing Address - Country:US
Mailing Address - Phone:518-462-0612
Mailing Address - Fax:518-462-1951
Practice Address - Street 1:31 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3527
Practice Address - Country:US
Practice Address - Phone:518-462-0612
Practice Address - Fax:518-462-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0138483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00515059Medicaid
3318993OtherNABP NUMBER
3318993OtherNABP NUMBER
NY00515059Medicaid