Provider Demographics
NPI:1932268307
Name:MARGARETVILLE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARGARETVILLE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-586-2631
Mailing Address - Street 1:42084 STATE HWY RT 28
Mailing Address - Street 2:
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455
Mailing Address - Country:US
Mailing Address - Phone:845-586-2631
Mailing Address - Fax:845-586-2539
Practice Address - Street 1:42084 STATE HWY RT 28
Practice Address - Street 2:
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455
Practice Address - Country:US
Practice Address - Phone:845-586-2631
Practice Address - Fax:845-586-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0163273336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279387Medicaid
NY330092Medicaid
2060477OtherPK