Provider Demographics
NPI:1821127820
Name:AVERYS PHARMACY INC
Entity Type:Organization
Organization Name:AVERYS PHARMACY INC
Other - Org Name:NORTH COLLINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:A
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-337-2992
Mailing Address - Street 1:10504 MAIN ST
Mailing Address - Street 2:PO BOX 579
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-0579
Mailing Address - Country:US
Mailing Address - Phone:716-337-2992
Mailing Address - Fax:716-337-3090
Practice Address - Street 1:10504 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111-0579
Practice Address - Country:US
Practice Address - Phone:716-337-2992
Practice Address - Fax:716-337-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183500000X
NY0166083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0719460001Medicare NSC