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Contact Information

PENN TRAFFIC COMPANY THE
2078 STATE ROUTE 481
FULTON, NY13069
 Phone: 315-592-3595
 Fax: 315-592-4889
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PENN TRAFFIC COMPANY THE

NPI Number 1790706026
LBN Legal business name PENN TRAFFIC COMPANY THE
Authorized official JAMES ERBA - (PHARMACY SYSTEMS MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/21/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
NY License # 022164
NY Medicaid 01483843
Other 3348112 OTHER ID NUMBER-COMMERCIAL NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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