Healthcare Provider Details

I. General information

NPI: 1780604173
Provider Name (Legal Business Name): WINDHAM PHARMACY OF GREENE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STATE ROUTE 296 SUITE 10
WINDHAM NY
12496-0068
US

IV. Provider business mailing address

PO BOX 68 3 RTE 296 & SOUTH STREET
WINDHAM NY
12468
US

V. Phone/Fax

Practice location:
  • Phone: 518-734-3033
  • Fax: 518-734-6575
Mailing address:
  • Phone: 518-734-3033
  • Fax: 518-734-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number018879
License Number StateNY

VIII. Authorized Official

Name: MR. WILLIAM T QUACKENBUSH III
Title or Position: PRESIDENT
Credential: RPH
Phone: 518-966-8714