Provider Demographics
NPI:1770677189
Name:FISHKILL PLAINS PHARMACY INC
Entity Type:Organization
Organization Name:FISHKILL PLAINS PHARMACY INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASIANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-897-0636
Mailing Address - Street 1:1004 MAIN ST
Mailing Address - Street 2:BLDG 554
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3509
Mailing Address - Country:US
Mailing Address - Phone:845-897-0636
Mailing Address - Fax:845-897-0638
Practice Address - Street 1:1004 MAIN ST
Practice Address - Street 2:BLDG 554
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3509
Practice Address - Country:US
Practice Address - Phone:845-897-0636
Practice Address - Fax:845-897-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0268533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3339050OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY02619950Medicaid
NY02619950Medicaid