CRM-Canandaigua LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

031319 Issued in NY

Legal business name

CRM-CANANDAIGUA LLC

Doing business as

The Medicine Shoppe Pharmacy

Practice address

75 Victor Heights Pkwy Ste C
Victor, NY 14564-8926

Phone

(585) 337-4300

Fax

(585) 396-7264

NPI assigned

Apr 18, 2012

Organization subpart

No

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

Authorized official

Name

Jeff Hetrick

Title

Chief Operating Officer

Phone

(716) 830-2518

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• The Medicine Shoppe Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1427315266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 VICTOR HEIGHTS PKWY STE C",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145648926",
            "telephone_number": "585-337-4300",
            "fax_number": "585-396-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 VICTOR HEIGHTS PKWY STE C",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145648926",
            "telephone_number": "585-337-4300",
            "fax_number": "585-396-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRM-CANANDAIGUA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "HETRICK",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "716-830-2518"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "031319",
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH 29053",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03467627",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136804",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Medicine Shoppe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jordan Leigh Coykendall, NP
• Tanya Crandall
• Karen M Crawford
• Dominic Joseph Crisafulli, RPH
• CRM-Canandaigua LLC
• Julia Beth Croft, MSPT
• Ian Crosby, LCSW
• Kelly Crosby
• Erin Cummings
• CVS Albany LLC

• Pharmacy in Victor, NY
• Providers in Victor, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.