Provider Demographics
NPI:1457808974
Name:RYE RIDGE PHARMACY, INC.
Entity Type:Organization
Organization Name:RYE RIDGE PHARMACY, INC.
Other - Org Name:RYE RIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-937-4444
Mailing Address - Street 1:146 S. RIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-937-4444
Mailing Address - Fax:914-481-4584
Practice Address - Street 1:146 S. RIDGE STREET
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-937-4444
Practice Address - Fax:914-481-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0350403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166199OtherPK