Provider Demographics
NPI:1740590058
Name:CHEM RX PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:CHEM RX PHARMACY SERVICES, LLC
Other - Org Name:CHEM RX PHARMACY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7429
Mailing Address - Street 1:12 INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5319
Mailing Address - Country:US
Mailing Address - Phone:518-452-7795
Mailing Address - Fax:518-452-4494
Practice Address - Street 1:12 INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-5319
Practice Address - Country:US
Practice Address - Phone:518-452-7795
Practice Address - Fax:518-452-4494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMERICA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03320385Medicaid
VT1026788Medicaid
5801988OtherNCPDP PROVIDER IDENTIFICATION NUMBER