Provider Demographics
NPI:1407038789
Name:DUPREY, PAT (RPH)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:
Last Name:DUPREY
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 1:3000 FORD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4480
Mailing Address - Country:US
Mailing Address - Phone:315-394-9592
Mailing Address - Fax:315-394-9727
Practice Address - Street 1:3000 FORD STREET EXT
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4480
Practice Address - Country:US
Practice Address - Phone:315-394-9592
Practice Address - Fax:315-394-9727
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01528032Medicaid