Provider Demographics
NPI:1326362732
Name:OVERSTROM, NANCY JEAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEAN
Last Name:OVERSTROM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 W PULTENEY ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2260
Mailing Address - Country:US
Mailing Address - Phone:607-936-3233
Mailing Address - Fax:607-936-2444
Practice Address - Street 1:98 W PULTENEY ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2260
Practice Address - Country:US
Practice Address - Phone:607-936-3233
Practice Address - Fax:607-936-2444
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044807-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044807-1OtherLICENSE