Ellicottville Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ELLICOTTVILLE PHARMACY INC

Doing business as

Park Pharmacy

Practice address

445 Broad St
Salamanca, NY 14779-1424

Phone

(716) 945-2140

Fax

(716) 945-0857

NPI assigned

Oct 20, 2006

Organization subpart

No

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

Authorized official

Name

Peter Illig, RPH

Title

Supervising RPH Sect Treas

Phone

(716) 945-2140

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PARK PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1235211020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 BROAD ST",
            "city": "SALAMANCA",
            "state": "NY",
            "postal_code": "147791424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 BROAD ST",
            "city": "SALAMANCA",
            "state": "NY",
            "postal_code": "147791424",
            "telephone_number": "716-945-2140",
            "fax_number": "716-945-0857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTTVILLE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "ILLIG",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "SUPERVISING RPH SECT TREAS",
        "authorized_official_telephone_number": "716-945-2140",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "019257",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00989322",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3388647",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melanye Christine Deuble-Hankins, RPA-C
• Carianne Dispigno, LMHC
• Kayley Dosser
• Joshua Dry
• Marilyn K Eddy-Siperek, LMHC
• Jason Emley
• Kristin Lyn Emley, COTA
• Family Practice Associates of Cattaraugus
• Kimberly Fischer, LMSW
• Emma Fiske, MS, CCC-SLP

• Community/Retail Pharmacy in Salamanca, NY
• Providers in Salamanca, 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 Sep 11, 2025; 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.