NPIMap

Organization Active NPI

Park Ridge Apothecary, Inc

  • Community/Retail Pharmacy
  • Rochester, NY
National Provider Identifier
1285679415
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
019921 Issued in NY
Legal business name
PARK RIDGE APOTHECARY, INC
Practice address
1561 Long Pond Rd
Ste 104
Rochester, NY 14626-4117
Phone
(585) 723-7340
Fax
(585) 723-7044
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Authorized official

Name
Marylynn Dandrea, RPH
Title
Supervisor,Pic,Ao
Phone
(585) 723-7340

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 019921 NY Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1561 Long Pond Rd
Ste 104
Rochester, NY 14626-4117

Mailing address

1561 Long Pond Rd
Ste 104
Rochester, NY 14626-4117
Phone (585) 723-7340

Other identifiers 2

IdentifierTypeStateIssuer
01092626MedicaidNY
2065525OtherPK

Other names 1

  • PARK RIDGE APOTHECARY INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171016002648 NY Part B Supplier - Pharmacy 7618243841 2 other NPIs on this enrollment
Practice locations: Clifton Springs, NY; Rochester, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Clifton Springs 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.

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1285679415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1561 LONG POND RD",
            "address_2": "STE 104",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264117",
            "telephone_number": "585-723-7340",
            "fax_number": "585-723-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1561 LONG POND RD",
            "address_2": "STE 104",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264117",
            "telephone_number": "585-723-7340",
            "fax_number": "585-723-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK RIDGE APOTHECARY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "DANDREA",
        "authorized_official_first_name": "MARYLYNN",
        "authorized_official_title_or_position": "SUPERVISOR,PIC,AO",
        "authorized_official_telephone_number": "585-723-7340",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "019921",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01092626",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2065525",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK RIDGE APOTHECARY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.