MEDICARE: OSWEGO VALLEY PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467481374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSWEGO VALLEY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	464 MAIN ST
Second Line	:
City	:	PHOENIX
State	:	NY
Zip	:	13135-2243
Country	:	US
Telephone Number	:	315-695-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 MAIN ST
Second Line	:
City	:	PHOENIX
State	:	NY
Zip	:	13135-2243
Country	:	US
Telephone Number	:	315-695-4200
Fax Number	:	315-695-6210

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. DAVID PAUL DINGMAN
Credential	:	RPH
Telephone Number	:	315-450-2678

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	12/17/2021

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