Provider Demographics
NPI:1922461540
Name:KATONAH PHARMACY INC
Entity Type:Organization
Organization Name:KATONAH PHARMACY INC
Other - Org Name:KATONAH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, MANAGER,AO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-232-2300
Mailing Address - Street 1:202 KATONAH AVE
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2110
Mailing Address - Country:US
Mailing Address - Phone:914-232-2300
Mailing Address - Fax:914-232-1130
Practice Address - Street 1:202 KATONAH AVE
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2110
Practice Address - Country:US
Practice Address - Phone:914-232-2300
Practice Address - Fax:914-232-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0346343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160958OtherPK