Healthcare Provider Details

I. General information

NPI: 1649502972
Provider Name (Legal Business Name): HUGH WALTER DAVIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 MAIN STREET
COPAKE NY
12516-0010
US

IV. Provider business mailing address

PO BOX 10
COPAKE NY
12516-0010
US

V. Phone/Fax

Practice location:
  • Phone: 518-329-4671
  • Fax: 518-329-6070
Mailing address:
  • Phone: 518-329-4671
  • Fax: 518-329-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: