Organization
ELLICOTTVILLE PHARMACY INC
Active
Other names
PARK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PETER ILLIG RPH (SUPERVISING RPH SECT TREAS)
(716) 945-2140
Entity
Organization
Contact information
Practice address
445 BROAD ST, SALAMANCA, NY 14779-1424
(716) 945-2140
(716) 945-0857
Mailing address
445 BROAD ST, SALAMANCA, NY 14779-1424
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
019257
NY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00989322
—
NY
01
—
3388647
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/20/2006
Last updated
09/11/2025
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