South Park Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

028253 Issued in NY

Legal business name

SOUTH PARK PHARMACY LLC

Doing business as

South Park Pharmacy

Practice address

2707 S Park Ave
Lackawanna, NY 14218-1511

Phone

(716) 823-0440

Fax

(716) 823-0444

NPI assigned

Feb 28, 2007

Last updated

Apr 21, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shawn Shelton, RPH

Title

Owner/Pic/Ao

Phone

(716) 823-0440

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SOUTH PARK PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Acevski, PHARMD

  • Pharmacist
  • Lackawanna, NY
  • NPI 1487008637
  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1922135763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 S PARK AVE",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181511",
            "telephone_number": "716-823-0440",
            "fax_number": "716-823-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 S PARK AVE",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181511",
            "telephone_number": "716-823-0440",
            "fax_number": "716-823-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "SHELTON",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "OWNER/PIC/AO",
        "authorized_official_telephone_number": "716-823-0440",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "028253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2068947",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02885981",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rosanne M Sheehan, P.T.
• Beth Ann Sheehy, SLP
• Karl N. Sheffield, SCHOOL PSYCHOLOGIST
• Mary A Smith
• Mary Beth Sojka, CDA,RDA
• Southtowns Dental Services PC
• Barbara Stengel, LCSW
• Paulette Lynn Stornelli, CDA,RDA
• Jaclyn Lee Strycharz, MSW
• Debra Lynn Stubeusz, MD

• Community/Retail Pharmacy in Lackawanna, NY
• Providers in Lackawanna, 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 Apr 21, 2017; 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.