| NPI | 1083779730 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2006-12-23 |
| Last Updated | 2026-01-21 |
| Authorized Official | Riaz Wattoo OWNER Phone: 8457444221 |
| Mailing Address | Po Box 1347 Pine Bush, NY 12566-1347 United States Phone: (845) 744-4221 | Fax: (845) 744-2046 📍 View Map |
| Primary Practice Address | 2412 State Route 52 Ste 5 Pine Bush, NY 12566-7037 United States Phone: (845) 744-4221 | Fax: (845) 744-2046 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | NY | 02385422 | - |
| Other (non-Medicare) | - | 2059454 | PK |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 3336C0003X – Pharmacy, Community/Retail Pharmacy | NY | 025835 |
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About NPI 1083779730
Pine Bush Pharmacy Inc is an organization registered in the CMS NPPES NPI Registry with NPI number 1083779730. The primary specialty listed is Pharmacy, Community/Retail Pharmacy. The organization is located in Pine Bush, NY. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-12-23. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1083779730?
NPI 1083779730 belongs to Pine Bush Pharmacy Inc, a Pharmacy, Community/Retail Pharmacy in Pine Bush, NY. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1083779730 active?
The current status of NPI 1083779730 in the NPPES registry is Active. The record was last updated on 2026-01-21.
What specialty is NPI 1083779730?
NPI 1083779730 is classified under the taxonomy Pharmacy, Community/Retail Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1083779730?
You can verify NPI 1083779730 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1083779730?
The primary practice address on file for NPI 1083779730 is 2412 State Route 52 Ste 5, Pine Bush, NY 12566-7037. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1083779730 issued?
NPI 1083779730 was first issued (enumerated) on 2006-12-23. The NPPES record was last updated on 2026-01-21.
Practice Location Map
Pine Bush Pharmacy Inc is located at 2412 State Route 52 Ste 5, Pine Bush, NY. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Pine Bush Pharmacy Inc. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1083779730. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Pharmacy, Community/Retail Pharmacy | 025835 | NY |