Provider Demographics
NPI:1154377190
Name:SEDGWICK PHARMACY INC
Entity type:Organization
Organization Name:SEDGWICK PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZAMUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-543-3116
Mailing Address - Street 1:3887 SEDGWICK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4401
Mailing Address - Country:US
Mailing Address - Phone:718-543-3116
Mailing Address - Fax:718-543-1071
Practice Address - Street 1:3887 SEDGWICK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4401
Practice Address - Country:US
Practice Address - Phone:718-543-3116
Practice Address - Fax:718-543-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436120001332B00000X
3336C0003X
NY0161783336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00301799Medicaid
NY00301799Medicaid