Provider Demographics
NPI:1265759815
Name:PROGRESSION LLC
Entity type:Organization
Organization Name:PROGRESSION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMOLLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:845-679-0790
Mailing Address - Street 1:79 TINKER ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1238
Mailing Address - Country:US
Mailing Address - Phone:845-679-0790
Mailing Address - Fax:845-679-0795
Practice Address - Street 1:79 TINKER ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1238
Practice Address - Country:US
Practice Address - Phone:845-679-0790
Practice Address - Fax:845-679-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030053OtherNYS PHARMACY LICENSE NUMBER
NY030053OtherNYS PHARMACY LICENSE NUMBER