Provider Demographics
NPI:1902575871
Name:NYS DOCCS WALSH RMU PHARMACY
Entity Type:Organization
Organization Name:NYS DOCCS WALSH RMU PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:315-339-5232
Mailing Address - Street 1:6514 ROUTE 26 PO BOX 8450
Mailing Address - Street 2:BUILDING 52
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13442-8450
Mailing Address - Country:US
Mailing Address - Phone:315-339-5232
Mailing Address - Fax:
Practice Address - Street 1:6514 ROUTE 26
Practice Address - Street 2:BUILDING 52
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13442-8450
Practice Address - Country:US
Practice Address - Phone:315-339-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK STATE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020715OtherNYS PHARMACY LICENSE