Provider Demographics
NPI:1972303790
Name:WATER STREET PHARMACY INC.
Entity type:Organization
Organization Name:WATER STREET PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:315-536-0100
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1247
Mailing Address - Country:US
Mailing Address - Phone:153-536-0100
Mailing Address - Fax:
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1247
Practice Address - Country:US
Practice Address - Phone:153-536-0100
Practice Address - Fax:315-536-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy