Healthcare Provider Details

I. General information

NPI: 1669455093
Provider Name (Legal Business Name): DAVCO DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 MAIN STREET
COPAKE NY
12516
US

IV. Provider business mailing address

PO BOX 10
COPAKE NY
12516-0010
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number019282
License Number StateNY

VIII. Authorized Official

Name: MR. HUGH WALTER DAVIS
Title or Position: PRESIDENT
Credential: RPH
Phone: 518-329-4671