NPIMap

Organization Active NPI

Keeseville Pharmacy Inc

  • Community/Retail Pharmacy
  • Keeseville, NY
National Provider Identifier
1245318658
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
017834 Issued in NY
Legal business name
KEESEVILLE PHARMACY INC
Doing business as
KEESEVILLE PHARMACY INC
Practice address
1730 Front St
Keeseville, NY 12944-3618
Phone
(518) 834-6090
Fax
(518) 834-7021
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Authorized official

Name
Daniel Bosley, RPHNPI 1881759819
Title
Supv PHRM
Phone
(518) 834-6090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 017834 NY Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1730 Front St
Keeseville, NY 12944-3618

Mailing address

1730 Front St
Keeseville, NY 12944-3618
Phone (518) 834-6090

Other identifiers 2

IdentifierTypeStateIssuer
00775571MedicaidNY
2061794OtherPK

Other names 1

  • KEESEVILLE PHARMACY INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130311000385 NY Part B Supplier - Mass Immunization (Roster Biller Only) 7012037849 Practice locations: Keeseville, NY
O20210216000540 NY Part B Supplier - Independent Clinical Laboratory 7012037849 Practice locations: Keeseville, NY

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1245318658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 FRONT ST",
            "city": "KEESEVILLE",
            "state": "NY",
            "postal_code": "129443618",
            "telephone_number": "518-834-6090",
            "fax_number": "518-834-7021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 FRONT ST",
            "city": "KEESEVILLE",
            "state": "NY",
            "postal_code": "129443618",
            "telephone_number": "518-834-6090",
            "fax_number": "518-834-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEESEVILLE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "BOSLEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "SUPV PHRM",
        "authorized_official_telephone_number": "518-834-6090",
        "authorized_official_credential": "RPH"
    },
    "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": "017834",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00775571",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2061794",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KEESEVILLE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keeseville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.