Provider Demographics
NPI:1215109418
Name:VANVALKENBURG, SCOTT HAMILTON (RPH)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HAMILTON
Last Name:VANVALKENBURG
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 1:5 RAVINE PARK N
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-4620
Mailing Address - Country:US
Mailing Address - Phone:607-431-1960
Mailing Address - Fax:
Practice Address - Street 1:99 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2470
Practice Address - Country:US
Practice Address - Phone:607-433-5101
Practice Address - Fax:607-433-5107
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist