Provider Demographics
NPI:1972785632
Name:BARBER, DARRELL (RPH)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:BARBER
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 1:94 DEMARS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-1442
Mailing Address - Country:US
Mailing Address - Phone:518-359-9173
Mailing Address - Fax:
Practice Address - Street 1:94 DEMARS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1442
Practice Address - Country:US
Practice Address - Phone:518-359-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist