Organization
NUNDA FAMILY PHARMACY LLC
Active
Other names
NUNDA FAMILY PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMIAH AXTELL RPH (OWNER)
(585) 468-2416
Entity
Organization
Contact information
Practice address
12 N STATE ST, NUNDA, NY 14517-0518
(585) 468-2416
(585) 468-5705
Mailing address
PO BOX 518, NUNDA, NY 14517-0518
(585) 468-2416
(585) 468-5705
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
027179
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02655952
—
NY
01
—
2063750
PK
—
Enumeration date
10/02/2006
Last updated
04/11/2017
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