Provider Demographics
NPI:1104685908
Name:MEAD SQUARE PHARMACY INC
Entity type:Organization
Organization Name:MEAD SQUARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-924-7970
Mailing Address - Street 1:7249 STATE ROUTE 96 STE B
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9009
Mailing Address - Country:US
Mailing Address - Phone:585-364-8980
Mailing Address - Fax:
Practice Address - Street 1:7249 STATE ROUTE 96 STE B
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9009
Practice Address - Country:US
Practice Address - Phone:585-364-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEAD SQUARE PHARMACY,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy