Active NPI
Mark T Edgerly, R.PH.
- Pharmacist
- Elmira, NY
National Provider Identifier
1861628927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 041156
- Practice address
- 100 Washington St
Elmira, NY 14901-2849 - Phone
- (607) 737-4703
- NPI assigned
- Jun 3, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 041156 | NY | Primary |
| Pharmacist | 183500000X | 14798 | NC |
Addresses
Primary practice location
100 Washington St
Elmira, NY 14901-2849
Mailing address
100 Washington St
Elmira, NY 14901-2849
Phone (607) 737-4703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041156 | NY | MD | Pharmacist |
| 14798 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243987200000",
"number": "1861628927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 WASHINGTON ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149012849",
"telephone_number": "607-737-4703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WASHINGTON ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149012849",
"telephone_number": "607-737-4703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDGERLY",
"first_name": "MARK",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-03",
"last_updated": "2009-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "041156",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "14798",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.