Organization
CRYSTAL RUN PHARMACY LLC
Active
Other names
CRYSTAL RUN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA AGNELLO (PHARMACIST IN CHARGE)
(845) 863-6750
Entity
Organization
Contact information
Practice address
731 ROUTE 211 E STE 108, MIDDLETOWN, NY 10941-1457
(845) 692-7628
(845) 692-7644
Mailing address
731 ROUTE 211 E STE 108, MIDDLETOWN, NY 10941-1457
(845) 692-7628
(845) 692-7644
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
027541
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053414532
NPI
—
05
—
2814744
—
NY
01
—
3352084
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/07/2006
Last updated
02/02/2024
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