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General NPI Number Information
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NPI Number | 1942273636
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Entity Type | Organization
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Legal Business Name | FAIRBANKS PHARMACY INC.
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Dates
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Enumeration Date | 02/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 37 MAIN ST
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City | SIDNEY
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State | NY
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Zip | 13838-1139
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Country | US
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Telephone | 607-563-1660
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Fax | 607-563-1762
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Provider Business Mailing Address
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Address Line | 37 MAIN ST
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City | SIDNEY
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State | NY
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Zip | 13838-1139
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Country | US
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Telephone | 607-563-1660
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Fax | 607-563-1762
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Authorized Official
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Title or Position | OWNER / CHIEF PHARMACIST
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Name | MR. DAVID E VANVALKENBURG
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Credential | R.PH.
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Telephone | 607-563-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 012692
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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