# CRYSTAL CITY APOTHECARY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1790566305
- **Authorized official:** MR. DONALD W GUTHRIE ROBERT PACKER HOSPITAL RPH (MEMBER)
- **Authorized official phone:** (160) 756-5239

## Contact information

- **Practice address:** 443 CAYUTA AVE, WAVERLY, NY 14892-1506
- **Practice address phone:** (607) 565-2390
- **Practice address fax:** (607) 565-2393
- **Mailing address:** 443 CAYUTA AVE, WAVERLY, NY 14892-1506
- **Mailing address phone:** (607) 565-2390
- **Mailing address fax:** (607) 565-2393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/10/2023
- **Last updated:** 10/10/2023