Provider Demographics
NPI:1902938749
Name:MAY, JACK T (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:T
Last Name:MAY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 N FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BURDETT
Mailing Address - State:NY
Mailing Address - Zip Code:14818-9639
Mailing Address - Country:US
Mailing Address - Phone:607-546-6870
Mailing Address - Fax:
Practice Address - Street 1:27 SHETHAR ST
Practice Address - Street 2:
Practice Address - City:HAMMONDSPORT
Practice Address - State:NY
Practice Address - Zip Code:14840
Practice Address - Country:US
Practice Address - Phone:607-569-2800
Practice Address - Fax:607-569-3250
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist