Provider Demographics
NPI:1568786010
Name:MAYER, GARY M (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:MAYER
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 1:31 INNSBRUCK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8315
Mailing Address - Country:US
Mailing Address - Phone:845-226-5383
Mailing Address - Fax:845-592-2759
Practice Address - Street 1:31 INNSBRUCK BLVD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-8315
Practice Address - Country:US
Practice Address - Phone:845-226-5383
Practice Address - Fax:845-592-2759
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYIO23554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist