Organization
PORT EWEN RX INC
Active
Other names
PORT EWEN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINAY ADUSUMILLI (MANAGER)
(440) 281-2324
Entity
Organization
Contact information
Practice address
177 BROADWAY, PORT EWEN, NY 12466-7719
(845) 331-4229
(845) 340-4593
Mailing address
PO BOX 759, PORT EWEN, NY 12466-0759
(845) 331-4229
(845) 340-4593
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
032682
NY
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147379
PK
—
Enumeration date
10/17/2013
Last updated
12/22/2020
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