Basic Information
| Provider Information | |||||||||
| NPI: | 1205904331 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOUR WINDS PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CROSS RIVER RD | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105363549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147638151 | ||||||||
| FaxNumber: | 8777269628 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 CROSS RIVER RD | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105363549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147638151 | ||||||||
| FaxNumber: | 8777269628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TANNONE | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PHARMACY | ||||||||
| AuthorizedOfficialTelephone: | 9147638151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | 015906 | NY | Y | Suppliers | Pharmacy | Institutional Pharmacy |
No ID Information.