Healthcare Provider Details

I. General information

NPI: 1780705954
Provider Name (Legal Business Name): ROBERT G CUDNEY JR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W STATE ST
BINGHAMTON NY
13901-2300
US

IV. Provider business mailing address

33 W STATE ST
BINGHAMTON NY
13901-2300
US

V. Phone/Fax

Practice location:
  • Phone: 607-723-8266
  • Fax: 607-722-0193
Mailing address:
  • Phone: 607-723-8266
  • Fax: 607-722-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number028650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: