Provider Demographics
NPI:1295012342
Name:OWEGO PHARMACY INC
Entity Type:Organization
Organization Name:OWEGO PHARMACY INC
Other - Org Name:THE OWEGO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GATTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:607-687-8779
Mailing Address - Street 1:1135 STATE ROUTE 17C
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-4823
Mailing Address - Country:US
Mailing Address - Phone:607-687-8779
Mailing Address - Fax:607-687-2135
Practice Address - Street 1:1135 STATE ROUTE 17C
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-4823
Practice Address - Country:US
Practice Address - Phone:607-687-8779
Practice Address - Fax:607-687-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03454877Medicaid
NY6696320001Medicare NSC