Provider Demographics
NPI:1992833255
Name:APPLE COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:APPLE COMMUNITY PHARMACY
Other - Org Name:APPLE COMMUNITY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-899-6063
Mailing Address - Street 1:3 HEMPHILL PL
Mailing Address - Street 2:STE 116
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4419
Mailing Address - Country:US
Mailing Address - Phone:518-899-6063
Mailing Address - Fax:518-899-6064
Practice Address - Street 1:3 HEMPHILL PL
Practice Address - Street 2:SUITE 116
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4419
Practice Address - Country:US
Practice Address - Phone:518-899-6063
Practice Address - Fax:518-899-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0207133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01198521Medicaid
3396909OtherNCPDP PROVIDER IDENTIFICATION NUMBER