Pendleton Star Pharmacy, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

042308 Issued in NY

Legal business name

PENDLETON STAR PHARMACY, INC.

Practice address

6503 Campbell Blvd
Lockport, NY 14094-9210

Phone

(716) 210-3152

NPI assigned

Aug 5, 2013

Last updated

Jan 25, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Judy Izard, RPHNPI 1720111065

Title

Owner/Supervisor

Phone

(716) 210-3152

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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.

• Judy Izard, RPH

  • Pharmacist
  • Lockport, NY
  • NPI 1720111065
  NPD Authorized official

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

{
    "created_epoch": "1375660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390608000000",
    "number": "1548692262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6503 CAMPBELL BLVD",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140949210",
            "telephone_number": "716-210-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6503 CAMPBELL BLVD",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140949210",
            "telephone_number": "716-210-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON STAR PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-05",
        "last_updated": "2014-01-25",
        "status": "A",
        "authorized_official_last_name": "IZARD",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "OWNER/SUPERVISOR",
        "authorized_official_telephone_number": "716-210-3152",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "042308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Lockport, NY
• Providers in Lockport, 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 25, 2014; 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.