=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063427698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICK J MCGAUGH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 LEBANON ST
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13346-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-824-3600
-----------------------------------------------------
Fax | 315-824-0044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 LEBANON ST
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13346-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-824-3600
-----------------------------------------------------
Fax | 315-824-0044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICK MCGAUGH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 315-824-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 024232
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------