Organization
ELLIS NOTT STREET PHARMACY LLC
Active
Other names
Nott Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN LANGE RPH (DIRECTOR OF PHARMACY/AO)
(518) 831-8874
Entity
Organization
Contact information
Practice address
1101 NOTT ST, SCHENECTADY, NY 12308-2425
(518) 612-8833
(518) 612-8873
Mailing address
1101 NOTT ST, SCHENECTADY, NY 12308-2425
(518) 612-8833
(518) 612-8873
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
035438
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05119122
—
NY
01
—
2169393
PK
—
Enumeration date
03/21/2017
Last updated
02/29/2024
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