Organization
LIVINGSTON MANOR PHARMACY LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHEETAL PATEL (MEMBER)
(845) 297-0549
Entity
Organization
Contact information
Practice address
47 STEWART AVE, ROSCOE, NY 12776-5105
(607) 498-4111
(607) 498-4113
Mailing address
PO BOX 146, ROSCOE, NY 12776-0146
(607) 498-4111
(607) 498-4113
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031823
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03929137
—
NY
01
—
2139292
PK
—
Enumeration date
03/11/2013
Last updated
12/01/2016
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