Active NPI
CCRX of New York, LLC
Doing business as MTM Pharmacy Services
- Pharmacy
- Albany, NY
National Provider Identifier
1417052846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 027847
- Legal business name
- CCRX OF NEW YORK, LLC
- Doing business as
- MTM Pharmacy Services
- Practice address
- 431 New Karner Rd
Albany, NY 12205-3868 - Phone
- (518) 862-2195
- Fax
- (518) 862-2199
- NPI assigned
- Sep 13, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Scott D Habecker
- Title
- Secretary
- Phone
- (717) 810-1950
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 027847 | NY | Primary |
Addresses
Primary practice location
431 New Karner Rd
Albany, NY 12205-3868
Mailing address
5775 Allentown Blvd
Suite 101
Harrisburg, PA 17112-4049
Phone (717) 810-1950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02749360 | Medicaid | NY |
Other names 1
- MTM Pharmacy Services
National Provider Directory
National Provider Directory- Tax ID family
- CCRX of New York LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
431 New Karner Rd
Albany, NY 12205
Phone (518) 372-2195
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Pharmacist
- Albany, NY
- NPI 1548582968
-
- Pharmacist
- Albany, NY
- NPI 1356665632
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1417052846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5775 ALLENTOWN BLVD",
"address_2": "SUITE 101",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171124049",
"telephone_number": "717-810-1950",
"fax_number": "717-810-1952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "431 NEW KARNER RD",
"city": "ALBANY",
"state": "NY",
"postal_code": "122053868",
"telephone_number": "518-862-2195",
"fax_number": "518-862-2199"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CCRX OF NEW YORK, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-13",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "HABECKER",
"authorized_official_first_name": "SCOTT",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "717-810-1950",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NY",
"license": "027847",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02749360",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MTM Pharmacy Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.