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NPI Code Detail

MEDICARE: MR. CALVIN STUART COOLIDGE REGISTER PHARMACIST

MEDICARE:  MR. CALVIN STUART COOLIDGE  REGISTER PHARMACIST
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
1183500000XPharmacist028645NY

General Provider Information

NPI Number : 1982884854
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CALVIN STUART COOLIDGE REGISTER PHARMACIST
Provider Business Mailing Address
First Line : 709 W UNION ST
Second Line :
City : NEWARK
State : NY
Zip : 14513-1357
Country : US
Telephone Number : 315-332-0193
Fax Number :
Provider Business Practice Location Address
First Line : 709 W UNION ST
Second Line :
City : NEWARK
State : NY
Zip : 14513-1357
Country : US
Telephone Number : 315-332-0193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2007
Last Update Date : 11/08/2007

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Directions to “ MR. CALVIN STUART COOLIDGE REGISTER PHARMACIST” Practice Location

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