Ivylea Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

028936 Issued in NY

Legal business name

IVYLEA PHARMACY INC

Doing business as

Ivylea Pharmacy

Practice address

2446 Elmwood Ave
Kenmore, NY 14217-2244

Phone

(716) 873-1444

Fax

(716) 873-5496

NPI assigned

Sep 12, 2006

Last updated

Apr 17, 2017By 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

Charles Barons, DOCTOR OF PHARM

Title

Supervising Pharmacist

Phone

(716) 873-1444

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• IVYLEA PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Tax ID family

Ivylea Pharmacy2 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.

• Ivylea Pharmacy Inc

  dba Ivylea Pharmacy

  • Long Term Care Pharmacy
  • Kenmore, NY
  • NPI 1376307306
  NPD tax ID

Practitioners 3

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.

• Charles Peter Barone Jr.

  • Pharmacist
  • Kenmore, NY
  • NPI 1578794236
  NPD
• James Russell Martin, PHARMD

  • Pharmacist
  • Kenmore, NY
  • NPI 1144654591
  NPD (past)
• Allyson Leigh Raditic, PHARMD

  • Pharmacist
  • Grand Island, NY
  • NPI 1639780265
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1144324104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2446 ELMWOOD AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172244",
            "telephone_number": "716-873-1444",
            "fax_number": "716-873-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2446 ELMWOOD AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172244",
            "telephone_number": "716-873-1444",
            "fax_number": "716-873-5496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYLEA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "BARONS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "SUPERVISING PHARMACIST",
        "authorized_official_telephone_number": "716-873-1444",
        "authorized_official_credential": "DOCTOR OF PHARM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "028936",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3125197",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03125197",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2059325",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVYLEA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul A. Imbert, MA, CCC-SLP
• Kaitlin Incorvia, LCSW
• Kayla Innocent
• Irshad Ali, MD
• Patricia M Irwin
• Ivylea Pharmacy Inc (Ivylea Pharmacy)
• Sadiyah Najmah Jackson
• Theresa Lynn Jackson, RD
• Kimberley Jakubiak, RPH
• James F Twist MD PC

• Community/Retail Pharmacy in Kenmore, NY
• Providers in Kenmore, 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 Apr 17, 2017; 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.