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General NPI Number Information
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NPI Number | 1275606097
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Entity Type | Organization
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Legal Business Name | WAYNE DRUG OF PULASKI, INC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 W BRIDGE ST
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City | OSWEGO
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State | NY
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Zip | 13126-2051
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Country | US
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Telephone | 315-343-5722
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Fax | 315-343-0085
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Provider Business Mailing Address
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Address Line | 24 W BRIDGE ST
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City | OSWEGO
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State | NY
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Zip | 13126-2051
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Country | US
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Telephone | 315-343-5722
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Fax | 315-343-0085
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES PATRICK BRANSHAW
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Credential | R.PH.
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Telephone | 315-343-5722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 019649
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License Number State | NY
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