Provider Demographics
NPI:1033365598
Name:PARTAIN, GARY (BS, RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:PARTAIN
Suffix:
Gender:M
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 WILBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4914
Mailing Address - Country:US
Mailing Address - Phone:845-471-7634
Mailing Address - Fax:
Practice Address - Street 1:2540 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5468
Practice Address - Country:US
Practice Address - Phone:845-483-9003
Practice Address - Fax:845-483-9015
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01319268Medicaid