Healthcare Provider Details

I. General information

NPI: 1942480280
Provider Name (Legal Business Name): JAMES E. MACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 11/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MORRIS ST
BATH NY
14810-1039
US

IV. Provider business mailing address

400 W MORRIS ST
BATH NY
14810-1039
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-3320
  • Fax: 607-776-1560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: