Eden Park Pharmacy Supply Co., Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

022310 Issued in NY

Legal business name

EDEN PARK PHARMACY SUPPLY CO., INC.

Practice address

16 Walker Way
Albany, NY 12205-4995

Phone

(518) 452-7795

NPI assigned

Nov 16, 2006

Organization subpart

No

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

Authorized official

Name

Robert Glock

Title

President

Phone

(518) 436-4731

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811060932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122091713",
            "telephone_number": "518-436-4731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WALKER WAY",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122054995",
            "telephone_number": "518-452-7795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PARK PHARMACY SUPPLY CO., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-436-4731"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "022310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02068037",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Albany, NY
• Providers in Albany, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.