# WOODMARK PHARMACY OF NEW YORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Woodmark Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225376098
- **Authorized official:** MR. SCOTT KRUSE RPH (DIRECTOR)
- **Authorized official phone:** (716) 260-6936

## Contact information

- **Practice address:** 1142 WEHRLE DR, WILLIAMSVILLE, NY 14221-7748
- **Practice address phone:** (716) 631-3381
- **Mailing address:** 641 LEXINGTON AVE, 31ST FLOOR, NEW YORK, NY 10022-4503
- **Mailing address phone:** (212) 802-7609
- **Mailing address fax:** (646) 924-0520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 031869 | NY | — |
| 3336L0003X | Long Term Care Pharmacy | 031869 | NY | Yes |

## Other

- **Enumeration date:** 01/29/2013
- **Last updated:** 08/24/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6864720001 | MEDICARE PTAN | NY |