Provider Demographics
NPI:1639630635
Name:GEROULD'S PROFESSIONAL PHARMACY INC.
Entity Type:Organization
Organization Name:GEROULD'S PROFESSIONAL PHARMACY INC.
Other - Org Name:GEROULD'S PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:607-732-0597
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-1309
Mailing Address - Country:US
Mailing Address - Phone:607-732-0597
Mailing Address - Fax:607-733-7911
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-1309
Practice Address - Country:US
Practice Address - Phone:607-733-6696
Practice Address - Fax:607-737-0567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEROULD'S PROFESSIONAL PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00358801Medicaid