Port Jervis Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PORT JERVIS PHARMACY LLC

Doing business as

Medicine Shoppe
Port Jervis Pharmacy

Practice address

15 Jersey Ave
Port Jervis, NY 12771-2436

Phone

(845) 856-6681

Fax

(845) 856-6532

NPI assigned

Aug 20, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chirag Modi, R.PH.

Title

Owner

Phone

(734) 377-2584

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 2

• MEDICINE SHOPPE Doing business as
• Port Jervis Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Janice Vicaretti

  • Pharmacist
  • Port Jervis, NY
  • NPI 1437342995
  NPD
• Amanda Springwaldt

  • Pharmacist
  • Port Jervis, NY
  • NPI 1558163576
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1053426098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 JERSEY AVE",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127712436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 JERSEY AVE",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127712436",
            "telephone_number": "845-856-6681",
            "fax_number": "845-856-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JERVIS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MODI",
        "authorized_official_first_name": "CHIRAG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-377-2584",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "024124",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01879923",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3374496",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Jervis Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen Ann Pollidore, NP
• Port Jervis Anesthesiology Associates, PLLC
• Port Jervis Chiropractic, P.C.
• Port Jervis City School District
• Port Jervis Family Health NP PC
• Port Jervis Volunteer Ambcorps
• Port Jervis Volunteer Ambulance Corps Inc
• Sheila Quinn
• Ralph Edward Bowman, Physician PC
• Mary Ann Ricci, CARC

• Community/Retail Pharmacy in Port Jervis, NY
• Providers in Port Jervis, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.