Provider Demographics
NPI:1912928235
Name:QUALITY MARKETS PENN TRAFFIC CO THE
Entity Type:Organization
Organization Name:QUALITY MARKETS PENN TRAFFIC CO THE
Other - Org Name:QUALITY MARKETS 6686
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:315-461-2595
Mailing Address - Street 1:53 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1303
Practice Address - Country:US
Practice Address - Phone:716-326-5959
Practice Address - Fax:716-326-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021714333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01428784Medicaid
NY1428784Medicaid
3333363OtherOTHER ID NUMBER-COMMERCIAL NUMBER