Active NPI
Pine Bush Pharmacy Inc
- Community/Retail Pharmacy
- Pine Bush, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- PINE BUSH PHARMACY INC
- Practice address
- 2412 RT 52 Valley Supreme Plaza
Pine Bush, NY 12566 - Phone
- (845) 744-4221
- Fax
- (845) 744-2046
- NPI assigned
- Jun 24, 2006
- 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
- Riaz Wattoo
- Title
- Owner
- Phone
- (845) 744-4221
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 025835 | NY | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
2412 RT 52 Valley Supreme Plaza
Pine Bush, NY 12566
Mailing address
PO Box 1347
Pine Bush, NY 12566-1347
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02385422 | Medicaid | NY | |
| 3331422 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
National Provider Directory
National Provider Directory- Tax ID family
- Pine Bush Pharmacy Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Pine Bush, NY
- NPI 1083779730
Locations
2412 Route 52
Pine Bush, NY 12566
Phone (845) 744-4221
Practitioners & affiliated clinicians
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.
-
- Pharmacist
- Pine Bush, NY
- NPI 1477877017
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1710913447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1347",
"city": "PINE BUSH",
"state": "NY",
"postal_code": "125661347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2412 RT 52 VALLEY SUPREME PLAZA",
"city": "PINE BUSH",
"state": "NY",
"postal_code": "12566",
"telephone_number": "845-744-4221",
"fax_number": "845-744-2046"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINE BUSH PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-24",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "WATTOO",
"authorized_official_first_name": "RIAZ",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "845-744-4221"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NY",
"license": "025835",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02385422",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3331422",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Pine Bush, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.