Healthcare Provider Details

I. General information

NPI: 1326259961
Provider Name (Legal Business Name): WAYNE DRUG OF PULASKI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W BRIDGE ST
OSWEGO NY
13126-2051
US

IV. Provider business mailing address

24 W BRIDGE ST
OSWEGO NY
13126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 315-343-5722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number19649
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number19649
License Number StateNY

VIII. Authorized Official

Name: MR. JAMES BRANSHAW
Title or Position: VICE PRESIDENT
Credential:
Phone: 315-343-5722