Healthcare Provider Details

I. General information

NPI: 1740796697
Provider Name (Legal Business Name): SUNY HEALTH SCIENCE CENTER AT SYRACUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST OUTPATIENT PHARMACY
SYRACUSE NY
13210
US

IV. Provider business mailing address

750 EAST ADAMS ST OUTPATIENT PHARMACY
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3784
  • Fax: 315-464-9995
Mailing address:
  • Phone: 315-464-3784
  • Fax: 315-464-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035949
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STUART WRIGHT
Title or Position: CFO
Credential:
Phone: 315-464-6530