# KMART PHARMACY CORPORATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639613607
- **Authorized official:** DR. LYNDA DAVIDSON PHARMD (DISTRICT MANAGER)
- **Authorized official phone:** (716) 982-1609

## Contact information

- **Practice address:** 171 DELAWARE AVE, SIDNEY, NY 13838-1349
- **Practice address phone:** (607) 563-9911
- **Practice address fax:** (607) 563-7004
- **Mailing address:** 171 DELAWARE AVE, SIDNEY, NY 13838-1349
- **Mailing address phone:** (607) 563-9911
- **Mailing address fax:** (607) 563-7004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | I062177 | NY | Yes |

## Other

- **Enumeration date:** 12/11/2016
- **Last updated:** 12/11/2016