Provider Demographics
NPI:1689296733
Name:ELLICOTTVILLE PHARMACY INC
Entity Type:Organization
Organization Name:ELLICOTTVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILROY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-699-2384
Mailing Address - Street 1:6133 ROUTE 219 S STE 1004
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-9613
Mailing Address - Country:US
Mailing Address - Phone:716-699-2384
Mailing Address - Fax:
Practice Address - Street 1:6133 ROUTE 219 S STE 1004
Practice Address - Street 2:
Practice Address - City:ELLICOTTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14731-9613
Practice Address - Country:US
Practice Address - Phone:716-699-2384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLICOTTVILLE PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy