South Park Pharmacy Llc
Community/Retail Pharmacy
2707 S Park Ave, Lackawanna
New York, 14218-1511
716-823-0440 716-823-0444
South Park Pharmacy Llc is a Community/Retail Pharmacy in Lackawanna, New York. It is located at 2707 S Park Ave, Lackawanna and it's customer support contact number is 716-823-0440. The authorized person of South Park Pharmacy Llc is Shawn Shelton, RPH who is Owner/pic/ao of the pharmacy and his contact number is 716-823-0440. Active license number of South Park Pharmacy Llc is 028253 for Community/Retail Pharmacy in New York. South Park Pharmacy Llc accepts medicare which means medicare covered patients will not be billed for any more than the Medicare deductible and coinsurance.
South Park Pharmacy Llc is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Pharmacy Details:
South Park Pharmacy Llc type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | South Park Pharmacy Llc |
| Type: | Community/Retail Pharmacy |
| Location: | 2707 S Park Ave, Lackawanna,
New York, 14218-1511 |
| Phone: | 716-823-0440 |
| Fax: | 716-823-0444 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Shawn Shelton |
| Credentials: | RPH |
| Position: | Owner/pic/ao |
| Contact Number: | 716-823-0440 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1922135763 |
| NPI Enumeration Date: | 28 Feb, 2007 |
| NPI Last Update On: | 21 Apr, 2017 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for South Park Pharmacy Llc are as mentioned below.
| Specialization | License Number | State | Status | |
| Community/Retail Pharmacy | 028253 | New York | Primary | |
| Pharmacy | | | Secondary | |
| Durable Medical Equipment & Medical Supplies | | | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 2068947 | Other | | Pk |
| 02885981 | Medicaid | New York | |
Medicare Enrollment:
South Park Pharmacy Llc is enrolled in medicare and it's Pac Id, enrollment Id, registered name and type is as stated below.
| PAC ID: |
Enrollment ID: |
Org Name | Medicare Entity Type |
| 5698970952 | O20100930062042 | South Park Pharmacy Llc | DME SUPPLIER - PHARMACY |
| 5698970952 | O20130313000271 | South Park Pharmacy Llc | PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY) |
Products Available:
South Park Pharmacy Llc has following products available for sale under medicare.
| Products: |
|---|
| • Blood Glucose Monitors & Supplies: Non-mail Order | • Orthoses: Off-the-shelf |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 2707 S Park Ave,
Lackawanna, New York |
| Zip: | 14218-1511 |
| Phone Number: | 716-823-0440 |
| Fax Number: | 716-823-0444 |
Patients can reach South Park Pharmacy Llc at
2707 S Park Ave, Lackawanna, New York or can
call on customer care at 716-823-0440.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.