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General NPI Number Information
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NPI Number | 1669565891
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Entity Type | Organization
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Legal Business Name | BAXTERS HAVERSTRAW, INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 23 SAMSONDALE PLAZA ROUTE 9W
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993
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Country | US
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Telephone | 845-429-1303
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Fax |
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Provider Business Mailing Address
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Address Line | 23 SAMSONDALE PLAZA ROUTE 9W
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993
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Country | US
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Telephone | 845-429-1303
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MR. STEPHEN VINETT
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Credential | RPH
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Telephone | 845-429-1303
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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 | 019426
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License Number State | NY
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