Provider Demographics
NPI:1063869238
Name:MIDDLETOWN LTC PHARMACY LLC
Entity type:Organization
Organization Name:MIDDLETOWN LTC PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-341-2700
Mailing Address - Street 1:280 ROUTE 211 E
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3109
Mailing Address - Country:US
Mailing Address - Phone:845-341-2700
Mailing Address - Fax:845-341-2715
Practice Address - Street 1:280 ROUTE 211 E
Practice Address - Street 2:SUITE 112
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3109
Practice Address - Country:US
Practice Address - Phone:845-341-2700
Practice Address - Fax:845-341-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04585449Medicaid
NY034715OtherSTATE BOARD OF PHARMACY
NY034715OtherSTATE BOARD OF PHARMACY
NY034715OtherSTATE BOARD OF PHARMACY