Provider Demographics
NPI:1942348834
Name:PORTVILLE PHARMACY INC
Entity Type:Organization
Organization Name:PORTVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PORTVILLE PHCY INC
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:VANCUREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMIACIST
Authorized Official - Phone:716-933-8251
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770-9794
Mailing Address - Country:US
Mailing Address - Phone:716-933-8251
Mailing Address - Fax:716-933-8793
Practice Address - Street 1:12 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-9794
Practice Address - Country:US
Practice Address - Phone:716-933-8251
Practice Address - Fax:716-933-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty