Provider Demographics
NPI:1699748350
Name:THRUWAY PHARMACY, INC.
Entity type:Organization
Organization Name:THRUWAY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-778-3535
Mailing Address - Street 1:78 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1054
Mailing Address - Country:US
Mailing Address - Phone:845-778-1388
Mailing Address - Fax:
Practice Address - Street 1:78 OAK ST
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1054
Practice Address - Country:US
Practice Address - Phone:845-778-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012219333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00498673Medicaid
NY00498673Medicaid