Healthcare Provider Details

I. General information

NPI: 1457537417
Provider Name (Legal Business Name): MARK JOHN OBUHANYCH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N MAIN ST
ELMIRA NY
14901-2104
US

IV. Provider business mailing address

301 PLAINFIELD RD SUITE #280
SYRACUSE NY
13212-4568
US

V. Phone/Fax

Practice location:
  • Phone: 607-271-9480
  • Fax: 607-271-9498
Mailing address:
  • Phone: 315-457-2531
  • Fax: 315-457-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: