Provider Demographics
NPI:1548567225
Name:HUDSON REGIONAL LTC PHARMACY INC
Entity type:Organization
Organization Name:HUDSON REGIONAL LTC PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGERAME
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RPH
Authorized Official - Phone:845-341-2714
Mailing Address - Street 1:280 ROUTE 211 E
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3109
Mailing Address - Country:US
Mailing Address - Phone:845-341-2700
Mailing Address - Fax:845-341-2715
Practice Address - Street 1:280 ROUTE 211 E
Practice Address - Street 2:SUITE 112
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3109
Practice Address - Country:US
Practice Address - Phone:845-341-2700
Practice Address - Fax:845-341-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0305423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03349511Medicaid
2128914OtherPK
NY03349511Medicaid