Healthcare Provider Details

I. General information

NPI: 1942273636
Provider Name (Legal Business Name): FAIRBANKS PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MAIN ST
SIDNEY NY
13838-1139
US

IV. Provider business mailing address

37 MAIN ST
SIDNEY NY
13838-1139
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-1660
  • Fax: 607-563-1762
Mailing address:
  • Phone: 607-563-1660
  • Fax: 607-563-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number012692
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID E VANVALKENBURG
Title or Position: OWNER / CHIEF PHARMACIST
Credential: R.PH.
Phone: 607-563-1660