Provider Demographics
NPI:1891023388
Name:WAMSLEY, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WAMSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548
Mailing Address - Country:US
Mailing Address - Phone:845-883-7469
Mailing Address - Fax:845-883-7530
Practice Address - Street 1:2066 ROUTE 32
Practice Address - Street 2:
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548
Practice Address - Country:US
Practice Address - Phone:845-883-7469
Practice Address - Fax:845-883-7530
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist