Healthcare Provider Details

I. General information

NPI: 1356494728
Provider Name (Legal Business Name): WATER STREET PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WATER ST
DUNDEE NY
14837-1028
US

IV. Provider business mailing address

14 WATER ST
DUNDEE NY
14837-1028
US

V. Phone/Fax

Practice location:
  • Phone: 607-243-8114
  • Fax: 607-243-8729
Mailing address:
  • Phone: 607-243-8114
  • Fax: 607-243-8729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number026395
License Number StateNY

VIII. Authorized Official

Name: TRACEY L KNAPP
Title or Position: OWNER
Credential: R.PH.
Phone: 607-243-8114