Provider Demographics
NPI:1780087494
Name:PROFESSIONAL COMMUNITY PHARMACIES INC
Entity type:Organization
Organization Name:PROFESSIONAL COMMUNITY PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-569-2221
Mailing Address - Street 1:55-57 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787
Mailing Address - Country:US
Mailing Address - Phone:716-326-5959
Mailing Address - Fax:716-569-2280
Practice Address - Street 1:55 E MAIN ST # 57
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1327
Practice Address - Country:US
Practice Address - Phone:716-326-5959
Practice Address - Fax:716-569-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0332773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04132707Medicaid
2148537OtherPK