Provider Demographics
NPI:1598862856
Name:PRIME CARE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:PRIME CARE PHARMACY SERVICES INC
Other - Org Name:PRIMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIGDALOS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:914-375-4300
Mailing Address - Street 1:5 ODELL PLZ
Mailing Address - Street 2:STE 141
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1406
Mailing Address - Country:US
Mailing Address - Phone:914-375-4300
Mailing Address - Fax:914-457-7626
Practice Address - Street 1:5 ODELL PLZ
Practice Address - Street 2:STE 141
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1406
Practice Address - Country:US
Practice Address - Phone:914-375-4300
Practice Address - Fax:914-457-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
NY0279933336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2814684Medicaid
2068517OtherPK
2068517OtherPK