Provider Demographics
NPI:1659744936
Name:BARTHS OF JAMESPORT INC
Entity Type:Organization
Organization Name:BARTHS OF JAMESPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-722-3900
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:JAMESPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11947-0667
Mailing Address - Country:US
Mailing Address - Phone:631-722-3900
Mailing Address - Fax:631-722-3999
Practice Address - Street 1:1491 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:JAMESPORT
Practice Address - State:NY
Practice Address - Zip Code:11947
Practice Address - Country:US
Practice Address - Phone:631-722-3900
Practice Address - Fax:631-722-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X, 333600000X
NY0344063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157371OtherPK