Provider Demographics
NPI:1629155361
Name:COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY INC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNACCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-278-2700
Mailing Address - Street 1:100 INDEPENDENT WAY
Mailing Address - Street 2:STE G
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-6301
Mailing Address - Country:US
Mailing Address - Phone:845-278-2700
Mailing Address - Fax:845-278-7339
Practice Address - Street 1:100 INDEPENDENT WAY
Practice Address - Street 2:STE G
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-6301
Practice Address - Country:US
Practice Address - Phone:845-278-2700
Practice Address - Fax:845-278-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0190633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2064381OtherPK
NY00754590Medicaid
NY1118200001Medicare NSC