Provider Demographics
NPI:1861563140
Name:PRIORITY PHARMACEUTICAL SERVICE LLC
Entity type:Organization
Organization Name:PRIORITY PHARMACEUTICAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LENIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-381-9033
Mailing Address - Street 1:1805 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3923
Mailing Address - Country:US
Mailing Address - Phone:518-381-9033
Mailing Address - Fax:518-374-6985
Practice Address - Street 1:1805 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-3923
Practice Address - Country:US
Practice Address - Phone:518-381-9033
Practice Address - Fax:518-374-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3321178OtherNABP
NY02117540Medicaid
NY024927OtherNYS PHARMACY LICENSE NUMB
NY024927OtherNYS PHARMACY LICENSE NUMB