Provider Demographics
NPI:1790963619
Name:OSTOYICH, MATTHEW J (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:OSTOYICH
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 1:4539 RT 9G
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5127
Mailing Address - Country:US
Mailing Address - Phone:518-537-4461
Mailing Address - Fax:518-537-4461
Practice Address - Street 1:1301 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1514
Practice Address - Country:US
Practice Address - Phone:845-336-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist