OrganizationActive
South Park Pharmacy LLC
NPI 1922135763 · Community/Retail Pharmacy · Lackawanna, NY
South Park Pharmacy LLC is a Community/Retail Pharmacy organization in Lackawanna, NY (NPI 1922135763).
Provider details
- NPI number
- 1922135763
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Shawn Shelton, Owner/Pic/Ao(716) 823-0440
Specialties & taxonomies
Suppliers
- Pharmacy333600000X
Suppliers
Suppliers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2707 S Park Ave
Lackawanna, NY 14218-1511
Phone: (716) 823-0440
Fax: (716) 823-0444
Street-level locationGet directions
Mailing address
2707 S Park Ave
Lackawanna, NY 14218-1511
Other names (DBA / former)
- Doing business as
- South Park Pharmacy
Registry dates
- Enumerated
- 2007-02-28
- Last updated
- 2017-04-21
Frequently asked questions
- What is South Park Pharmacy LLC's NPI number?
- South Park Pharmacy LLC's National Provider Identifier (NPI) is 1922135763, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is South Park Pharmacy LLC?
- South Park Pharmacy LLC is classified in the NPPES registry as Community/Retail Pharmacy (Suppliers).
- Where is South Park Pharmacy LLC located?
- South Park Pharmacy LLC's practice location on file with NPPES is 2707 S Park Ave, Lackawanna, NY 14218-1511.
- What is South Park Pharmacy LLC's phone number?
- The practice phone number listed in the NPPES registry for South Park Pharmacy LLC is (716) 823-0440.
- Who is the authorized official for South Park Pharmacy LLC?
- The authorized official listed on South Park Pharmacy LLC's NPPES record is Shawn Shelton, Owner/Pic/Ao. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is South Park Pharmacy LLC's NPI active?
- Yes — South Park Pharmacy LLC's NPI (1922135763) is active in the NPPES registry as of the last update on 2017-04-21.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.