ER Black Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

024930 Issued in NY

Legal business name

ER BLACK PHARMACY INC

Practice address

9553 Main Street
Holland Patent, NY 13354-0205

Phone

(315) 865-8141

Fax

(315) 865-4318

NPI assigned

Jan 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Earl Robert Black Jr., R PHNPI 1114185642

Title

President Pharmacist

Phone

(315) 865-8141

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Holland Patent Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

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

• Earl Robert Black, RPH

  • Pharmacist
  • Manlius, NY
  • NPI 1114185642
  NPD Authorized official
• Ashley Lynn Mundrick, PHARMD

  • Pharmacist
  • Holland Patent, NY
  • NPI 1376897066
  NPD (past)
• Matthew Tennyson, PHARMD.

  • Pharmacist
  • Holland Patent, NY
  • NPI 1992583306
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1467519009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9553 MAIN ST",
            "city": "HOLLAND PATENT",
            "state": "NY",
            "postal_code": "13354",
            "telephone_number": "315-865-8141",
            "fax_number": "315-865-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9553 MAIN STREET",
            "city": "HOLLAND PATENT",
            "state": "NY",
            "postal_code": "133540205",
            "telephone_number": "315-865-8141",
            "fax_number": "315-865-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ER BLACK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT PHARMACIST",
        "authorized_official_telephone_number": "315-865-8141",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "R PH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "024930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP #",
            "identifier": "3332727",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02139724",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holland Patent Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Lynn Almy, OTR/L
• Judith A Balch, FNP
• Pamela S Donovan, MS, CCC
• Michelle Lynn Dudrak-Farrell, OTR/L
• Tracy A Dulan, PTA
• Thomas Fiore, R.PH.
• Shawna M Fox, SPEECH THERAPIST
• Holland Patent Central School District
• Lisa Anne Kimball
• Tracy Leanne-Basi, RN

• Pharmacy in Holland Patent, NY
• Providers in Holland Patent, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.