Vince'S Pharmacy of Camillus Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

018681 Issued in NY

Legal business name

VINCE'S PHARMACY OF CAMILLUS INC

Practice address

240 Township Blvd Ste 30
Camillus, NY 13031-1793

Phone

(315) 487-5775

Fax

(315) 487-4423

NPI assigned

Oct 9, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Machen, PHARMDNPI 1497036875

Title

President

Phone

(315) 487-5775

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• the medicine shoppe Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Machen, PHARMD

  • Pharmacist
  • Camillus, NY
  • NPI 1497036875
  NPD Authorized official
• Vincent Patrick Massaro

  • Pharmacist
  • Camillus, NY
  • NPI 1548585839
  NPD (past)

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1114014164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 TOWNSHIP BLVD STE 30",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130311793",
            "telephone_number": "315-487-5775",
            "fax_number": "315-487-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 TOWNSHIP BLVD STE 30",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130311793",
            "telephone_number": "315-487-5775",
            "fax_number": "315-487-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINCE'S PHARMACY OF CAMILLUS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2023-03-07",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "MACHEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-487-5775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "018681",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "3384928",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00905748",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "the medicine shoppe",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "the medicine shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katrina Briceland Van Der Kloet, PHARM. D.
• Mari-Lee L Van Scoter
• Michelle Vanhatten, LMFT
• Stacia L Vanslyke, MD
• Toni Jean Vella, LPN
• Vince'S Pharmacy of Camillus Inc
• Linda Vincent Riker, RN, LMSW
• Margaret V Wade, NP
• Josierem Concellado Waite, RN
• Wal-Mart Stores East LP

• Community/Retail Pharmacy in Camillus, NY
• Providers in Camillus, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.