# KEESEVILLE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Keeseville Pharmacy, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932639937
- **Authorized official:** DANIEL BOSLEY (PHARMACIST)
- **Authorized official phone:** (518) 834-6090

## Contact information

- **Practice address:** 1730 FRONT ST, KEESEVILLE, NY 12944-3618
- **Practice address phone:** (518) 834-6090
- **Practice address fax:** (518) 834-7021
- **Mailing address:** 1730 FRONT ST, KEESEVILLE, NY 12944-3618
- **Mailing address phone:** (518) 834-6090
- **Mailing address fax:** (518) 834-7021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 017834 | NY | Yes |

## Other

- **Enumeration date:** 06/13/2017
- **Last updated:** 07/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00775571 | — | NY |
| 01 | — | 2169937 | PK | — |