Organization
CRYSTAL CITY APOTHECARY LLC
Active
Other names
WAVERLY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD SASSMAN RPH (OWNER AND PIC)
(607) 565-2390
Entity
Organization
Contact information
Practice address
443 CAYUTA AVE, WAVERLY, NY 14892-1506
(607) 565-2390
(607) 565-2393
Mailing address
443 CAYUTA AVE, WAVERLY, NY 14892-1506
(607) 565-2390
(607) 565-2393
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
027521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02708529
—
NY
01
—
3348629
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/13/2006
Last updated
12/22/2010
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