Healthcare Provider Details

I. General information

NPI: 1225178882
Provider Name (Legal Business Name): STAMFORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAIN ST
STAMFORD NY
12167-1159
US

IV. Provider business mailing address

119 MAIN ST
STAMFORD NY
12167-1159
US

V. Phone/Fax

Practice location:
  • Phone: 607-652-7233
  • Fax:
Mailing address:
  • Phone: 607-652-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number009314
License Number StateNY

VIII. Authorized Official

Name: VERN BARNES
Title or Position: PRESIDENT
Credential:
Phone: 607-652-7458