Provider Demographics
NPI:1669755666
Name:HARBOR PHARMACY OF UTICA LLC
Entity type:Organization
Organization Name:HARBOR PHARMACY OF UTICA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-342-6822
Mailing Address - Street 1:24 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2051
Mailing Address - Country:US
Mailing Address - Phone:315-735-3300
Mailing Address - Fax:315-342-5951
Practice Address - Street 1:918 JAMES ST STE B1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2500
Practice Address - Country:US
Practice Address - Phone:315-342-6822
Practice Address - Fax:315-342-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336H0001X
NY0310333336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133109OtherPK