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Organization
WATERVLIET PHARMACY ACQUISITION, LLC
Active
Organization
WATERVLIET PHARMACY ACQUISITION, LLC
Active
Other names
ConnectRx Hometown
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA MARIE HOTALING (DIRECTOR)
(518) 273-1402
Entity
Organization
Contact information
Practice address
601 19TH ST, WATERVLIET, NY 12189-2002
(518) 273-1402
(518) 687-0672
Mailing address
601 19TH ST, WATERVLIET, NY 12189-2002
(518) 273-1402
(518) 687-0672
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
015710
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00522647
—
NY
01
—
2065819
PK
—
Enumeration date
08/20/2006
Last updated
02/07/2022
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