Provider Demographics
NPI:1396284519
Name:HOPEWELL DRUGSTORE INC
Entity type:Organization
Organization Name:HOPEWELL DRUGSTORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-592-1717
Mailing Address - Street 1:410 ROUTE 376
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-4007
Mailing Address - Country:US
Mailing Address - Phone:845-592-1717
Mailing Address - Fax:845-592-1717
Practice Address - Street 1:410 ROUTE 376 STE 3
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-4008
Practice Address - Country:US
Practice Address - Phone:845-592-1717
Practice Address - Fax:845-592-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0352883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168287OtherPK