Provider Demographics
NPI:1811009822
Name:MIDDLETOWN APOTHECARY INC
Entity Type:Organization
Organization Name:MIDDLETOWN APOTHECARY INC
Other - Org Name:MIDDLETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOPA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-342-5566
Mailing Address - Street 1:149 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3721
Mailing Address - Country:US
Mailing Address - Phone:845-342-5566
Mailing Address - Fax:845-342-4986
Practice Address - Street 1:149 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3721
Practice Address - Country:US
Practice Address - Phone:845-342-5566
Practice Address - Fax:845-342-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0200463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01110925Medicaid
2065584OtherPK
0867490001Medicare NSC