Provider Demographics
NPI:1700231073
Name:HUDSON PHARMACY AND SURGICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:HUDSON PHARMACY AND SURGICAL SUPPLIES INC.
Other - Org Name:HUDSON PHARMACY & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISIING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUSTACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-941-4476
Mailing Address - Street 1:40 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4716
Mailing Address - Country:US
Mailing Address - Phone:914-941-4476
Mailing Address - Fax:914-236-3716
Practice Address - Street 1:40 SPRING ST
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4716
Practice Address - Country:US
Practice Address - Phone:914-941-4476
Practice Address - Fax:914-236-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0153493336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159667OtherPK
NY00513671Medicaid
NY00513671Medicaid