CCRX of New York, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

027843 Issued in NY

Legal business name

CCRX OF NEW YORK, LLC

Doing business as

MTM Pharmacy Services

Practice address

84 Patrick LN
Poughkeepsie, NY 12603-2936

Phone

(845) 485-3784

Fax

(845) 485-2853

NPI assigned

Aug 24, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Scott D Habecker

Title

Secretary

Phone

(717) 810-1950

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MTM Pharmacy Services Doing business as

Tax ID family

CCRX of New York LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• CCRX of New York, LLC

  dba MTM Pharmacy Services

  • Pharmacy
  • Albany, NY
  • NPI 1417052846
  NPD tax ID

Locations

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083721104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5775 ALLENTOWN BLVD",
            "address_2": "SUITE 101",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171124049",
            "telephone_number": "717-810-1950",
            "fax_number": "717-810-1952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 PATRICK LN",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032936",
            "telephone_number": "845-485-3784",
            "fax_number": "845-485-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRX OF NEW YORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HABECKER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "717-810-1950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "027843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02749379",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MTM Pharmacy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Veronica Ann Cavalla, RN
• Erica Cavallo-Olivo, M.D.
• Glenn James Cavanagh, CRNA
• Caroline Kay Cave, M.S., CCC-SLP
• Patricia Cave, PT
• CDB Chiropractic PC
• Jesse Cecil, MD
• Dora Celestino
• Mary Grace Centeno, MD
• Centered Health

• Pharmacy in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.