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CRYSTAL CITY APOTHECARY LLC NPI 1639111412


NPI Information

NPI: 1639111412
Provider Name: CRYSTAL CITY APOTHECARY LLC

Doing Business As: WAVERLY PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
443 CAYUTA AVE
WAVERLY, NY
ZIP 14892
Phone: (607) 565-2390
Get Directions

CRYSTAL CITY APOTHECARY LLC is a community/retail pharmacy pharmacy in Waverly, NY. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. CRYSTAL CITY APOTHECARY LLC NPI is 1639111412. The provider is registered as an organization entity type.
The provider Is Doing Business As Waverly Pharmacy.

The provider's business location address is:

443 CAYUTA AVE
WAVERLY, NY
ZIP 14892-506
Phone: (607) 565-2390
Fax: (607) 565-2393

The provider's authorized official is Donald Sassman .
The authorized official title is Owner And Pic and has the following contact phone number (607) 565-2390.

The enumeration date for this NPI number is 6/13/2006 and was last updated on 12/22/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail Pharmacy027521NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13348629OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
25479460002MEDICARE NSC
302708529MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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