Provider Demographics
NPI:1891333001
Name:FISHKILL PHARMACY LLC
Entity Type:Organization
Organization Name:FISHKILL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAIMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-331-5959
Mailing Address - Street 1:1004 MAIN ST BLDG 554
Mailing Address - Street 2:
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 BLDG 554
Practice Address - Street 2:
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:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031825Medicaid