Provider Demographics
NPI:1629089271
Name:MAGGY PHARMACY INC
Entity Type:Organization
Organization Name:MAGGY PHARMACY INC
Other - Org Name:MAGGY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-492-7130
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:DANNEMORA
Mailing Address - State:NY
Mailing Address - Zip Code:12929-0369
Mailing Address - Country:US
Mailing Address - Phone:518-492-7130
Mailing Address - Fax:518-492-7311
Practice Address - Street 1:1165 RT 374
Practice Address - Street 2:
Practice Address - City:DANNEMORA
Practice Address - State:NY
Practice Address - Zip Code:12929
Practice Address - Country:US
Practice Address - Phone:518-492-7130
Practice Address - Fax:518-492-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0123583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606060Medicaid
2064782OtherPK
NY00606060Medicaid