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NPI Code Detail

MEDICARE: MR. MARK JOHN OBUHANYCH R.PH.

MEDICARE: MR. MARK JOHN OBUHANYCH R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist042620NY

General Provider Information

NPI Number : 1457537417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK JOHN OBUHANYCH R.PH.
Provider Business Mailing Address
First Line : 301 PLAINFIELD RD
Second Line : SUITE #280
City : SYRACUSE
State : NY
Zip : 13212-4568
Country : US
Telephone Number : 315-457-2531
Fax Number : 315-457-2856
Provider Business Practice Location Address
First Line : 402 N MAIN ST
Second Line :
City : ELMIRA
State : NY
Zip : 14901-2104
Country : US
Telephone Number : 607-271-9480
Fax Number : 607-271-9498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2008
Last Update Date : 03/21/2008

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