Basic Information
| Provider Information | |||||||||
| NPI: | 1831187202 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RLJ PHARMACY INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | KATONAH PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 294 KATONAH AVE | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105362148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142323200 | ||||||||
| FaxNumber: | 9142323505 | ||||||||
| Practice Location | |||||||||
| Address1: | 294 KATONAH AVE | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105362148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142323200 | ||||||||
| FaxNumber: | 9142323505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GIANNONE | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPV PHCIST | ||||||||
| AuthorizedOfficialTelephone: | 9142323200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | 024641 | NY | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 02316723 | 05 | NY | MEDICAID | 3371729 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |