Provider Demographics
NPI:1851322937
Name:KINNEY DRUGS, INC. #88
Entity Type:Organization
Organization Name:KINNEY DRUGS, INC. #88
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-287-3600
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:NY
Mailing Address - Zip Code:13803-0284
Mailing Address - Country:US
Mailing Address - Phone:607-849-6156
Mailing Address - Fax:607-849-6111
Practice Address - Street 1:6 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:NY
Practice Address - Zip Code:13803-0284
Practice Address - Country:US
Practice Address - Phone:607-849-6156
Practice Address - Fax:607-849-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0278333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02752409Medicaid
NY0535600089Medicare NSC