Peg Apothecary Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

047516 Issued in NY

Legal business name

PEG APOTHECARY INC

Doing business as

Emerald Pharmacy

Practice address

4295 Katonah Ave
Bronx, NY 10470

Phone

(718) 944-0862

Fax

(718) 944-0864

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. William Shawn Nealis, RPHNPI 1023331485

Title

President

Phone

(718) 944-0862

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Emerald Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• William Shawn Nealis, RPH

  • Pharmacist
  • Bronx, NY
  • NPI 1023331485
  NPD Authorized official

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1770678666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4295 KATONAH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10470",
            "telephone_number": "718-944-0862",
            "fax_number": "718-944-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4295 KATONAH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10470",
            "telephone_number": "718-944-0862",
            "fax_number": "718-944-0864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEG APOTHECARY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "NEALIS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "SHAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-944-0862",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "047516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00290857",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS PHARMACY LIC",
            "identifier": "025341",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3325835",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emerald Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susana Paula Pedro, CRNA
• Melissa Pedroza, PSYD
• Angella Maurine Peele
• Staci Peete, LCSW
• Elena Peeva, MD
• Calista Pegeder, MS, CF-SLP, TSSLD
• Leotilde Peguero Cabrera
• Anilda Peguero Rodriguez
• Danny Peguero
• Juana Fadrina Peguero, LMSW,CASAC-T, QI

• Pharmacist in Bronx, NY
• Providers in Bronx, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.