Healthcare Provider Details

I. General information

NPI: 1669697884
Provider Name (Legal Business Name): JAMES WILBERT DENNIS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MILTON AVE
LIBERTY NY
12754-1334
US

IV. Provider business mailing address

19 MILTON AVE
LIBERTY NY
12754-1334
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-5421
  • Fax: 845-292-5421
Mailing address:
  • Phone: 845-292-5421
  • Fax: 845-292-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: