Provider Demographics
NPI:1164566501
Name:VANKUREN, SCOTT W (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:VANKUREN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12122-0937
Mailing Address - Country:US
Mailing Address - Phone:518-827-6602
Mailing Address - Fax:518-827-6609
Practice Address - Street 1:4448 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:MIDDLEBURGH
Practice Address - State:NY
Practice Address - Zip Code:12122-5706
Practice Address - Country:US
Practice Address - Phone:518-827-4488
Practice Address - Fax:518-827-4477
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037836OtherSTATE LIC