Medford Compounding & Specialty Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

031387 Issued in NY

Legal business name

MEDFORD COMPOUNDING & SPECIALTY PHARMACY LLC

Practice address

2612 Route 112
Medford, NY 11763-2522

Phone

(631) 693-1403

Fax

(631) 654-1508

NPI assigned

Aug 29, 2012

Organization subpart

No

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

Authorized official

Name

Crystal Koller

Title

VPF

Phone

(631) 475-4141

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Medford Compounding & Specialty Pharmacy LLC Doing business as

Locations

Practitioners 1

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

• Ann Palmer

  • Pharmacist
  • Medford, NY
  • NPI 1124400387
  NPD (past)

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1669721239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 ROUTE 112",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632551",
            "telephone_number": "631-475-4141",
            "fax_number": "631-475-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2612 ROUTE 112",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632522",
            "telephone_number": "631-693-1403",
            "fax_number": "631-654-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFORD COMPOUNDING & SPECIALTY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-29",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "KOLLER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "VPF",
        "authorized_official_telephone_number": "631-475-4141"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NY",
            "license": "031387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136843",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medford Compounding & Specialty Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacy R McCabe, LPN
• John McCarthy
• Kaitlin McGuire
• Sherry L. McPherson-Berg, LCSW-R
• Medford Chemists Inc.
• Medford Dialysis Access P.C.
• Medford Hamlet, LLC
• Medford Volunteer Ambulance, Inc.
• Medivault Labs
• Laura Ruth Melilli, LPN

• Compounding Pharmacy in Medford, NY
• Providers in Medford, NY by specialty
• Compounding Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.