Provider Demographics
NPI:1750489787
Name:PELELLA APOTHECARY INC
Entity Type:Organization
Organization Name:PELELLA APOTHECARY INC
Other - Org Name:HAZARDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEKOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:845-534-4345
Mailing Address - Street 1:290 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1579
Mailing Address - Country:US
Mailing Address - Phone:845-534-4345
Mailing Address - Fax:914-534-4048
Practice Address - Street 1:290 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1579
Practice Address - Country:US
Practice Address - Phone:845-534-4345
Practice Address - Fax:914-534-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0193483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2064534OtherPK
NY01042144Medicaid
0838190001Medicare NSC