Provider Demographics
NPI:1619987609
Name:TOWN CENTER PHARMACY, INC.
Entity Type:Organization
Organization Name:TOWN CENTER PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:914-765-0600
Mailing Address - Street 1:575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1891
Mailing Address - Country:US
Mailing Address - Phone:914-765-0600
Mailing Address - Fax:914-765-0188
Practice Address - Street 1:575 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1891
Practice Address - Country:US
Practice Address - Phone:914-765-0600
Practice Address - Fax:914-765-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2614919Medicaid
NY2614919Medicaid