Provider Demographics
NPI:1346384781
Name:SCHOHARIE VALLEY PHARMACY INC
Entity Type:Organization
Organization Name:SCHOHARIE VALLEY PHARMACY INC
Other - Org Name:VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:VANKUREN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-827-4488
Mailing Address - Street 1:4448 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12122-5706
Mailing Address - Country:US
Mailing Address - Phone:518-827-4488
Mailing Address - Fax:518-827-4477
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0204563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3395591OtherNABP
NY01159773Medicaid