Provider Demographics
NPI:1790928943
Name:MONROE PHARMACY LLC
Entity Type:Organization
Organization Name:MONROE PHARMACY LLC
Other - Org Name:MONROE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEKKAKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-271-1140
Mailing Address - Street 1:2672 RIDGE RD W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3027
Mailing Address - Country:US
Mailing Address - Phone:585-723-1755
Mailing Address - Fax:585-723-1764
Practice Address - Street 1:2672 RIDGE RD W
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3027
Practice Address - Country:US
Practice Address - Phone:585-723-1755
Practice Address - Fax:585-723-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3362403OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY6349220001Medicare NSC