Ellis Nott Street Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

035438 Issued in NY

Legal business name

ELLIS NOTT STREET PHARMACY LLC

Practice address

1101 Nott St
Schenectady, NY 12308-2425

Phone

(518) 612-8833

Fax

(518) 612-8873

NPI assigned

Mar 21, 2017

Reactivated

May 20, 2022

Organization subpart

No

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

Authorized official

Name

Jean Lange, RPH

Title

Director of Pharmacy/Ao

Phone

(518) 831-8874

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Nott Street Pharmacy Other name

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.

Medicare medical equipment & supply locations

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Ellis Hospital

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1487644993

  Member Of

  NPD member

Practitioners 2

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

• Nicole Danielle Jaeger, PHARM.D.

  • Pharmacist
  • Schenectady, NY
  • NPI 1710161468
  NPD
• Michael V Pasquarella, PHARMD

  • Pharmacist
  • Schenectady, NY
  • NPI 1396523866
  NPD

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1871024992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 NOTT ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123082425",
            "telephone_number": "518-612-8833",
            "fax_number": "518-612-8873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 NOTT ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123082425",
            "telephone_number": "518-612-8833",
            "fax_number": "518-612-8873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS NOTT STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "deactivation_date": "2022-03-28",
        "reactivation_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "LANGE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY/AO",
        "authorized_official_telephone_number": "518-831-8874",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "035438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05119122",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169393",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nott Street Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ellis Hospital
• Ellis Hospital
• Ellis Hospital
• Ellis Hospital
• Ellis Hospital
• Ellis Pathology Associates PC
• Emergency Medical Associates, PLLC
• Mallory Emerson, CD(PALS), CFSD(BADT)
• Empire Vision Center Inc
• Empire Vision Center, Inc.

• Community/Retail Pharmacy in Schenectady, NY
• Providers in Schenectady, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; 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.