NPIMap

Organization Active NPI

Crystal Run Pharmacy LLC

  • Long Term Care Pharmacy
  • Middletown, NY
National Provider Identifier
1770346793
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
CRYSTAL RUN PHARMACY LLC
Practice address
731 Route 211 E
Middletown, NY 10941-1445
Phone
(845) 692-7628
Fax
(845) 692-7644
NPI assigned
Feb 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Authorized official

Name
Mrs. Sandra Angela AgnelloNPI 1174855266
Title
President
Phone
(845) 692-7628

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

731 Route 211 E
Middletown, NY 10941-1445

Mailing address

731 Route 211 E
Middletown, NY 10941-1445
Phone (845) 692-7628

National Provider Directory

National Provider Directory
Tax ID family
Crystal Run Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

731 Route 211 E
Middletown, NY 10941
Phone (845) 692-7628

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1770346793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 ROUTE 211 E",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411445",
            "telephone_number": "845-692-7628",
            "fax_number": "845-692-7644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 ROUTE 211 E",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411445",
            "telephone_number": "845-692-7628",
            "fax_number": "845-692-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL RUN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "AGNELLO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "ANGELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-692-7628",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.