Active NPI
Dale McIntyre, R.PH.
- Pharmacist
- Watertown, NY
National Provider Identifier
1760704795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20 047506
- Practice address
- 905 Coffeen St
Watertown, NY 13601-1816 - Phone
- (315) 788-9366
- Fax
- (315) 405-8473
- NPI assigned
- Feb 17, 2010
- Last updated
- Feb 17, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20 047506 | NY | Primary |
Addresses
Primary practice location
905 Coffeen St
Watertown, NY 13601-1816
Mailing address
22532 Cullen Dr
Watertown, NY 13601-1797
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20 047506 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KPH Healthcare Services, Inc. | Past | Accepting new patients | |
| KPH Healthcare Services, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Kinney Drugs #30
- Community/Retail Pharmacy
- Watertown, NY
- NPI 1952418675
-
dba Kinney Drugs #153
- Community/Retail Pharmacy
- Brattleboro, VT
- NPI 1407747157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266364800000",
"number": "1760704795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22532 CULLEN DR",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136011797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 COFFEEN ST",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136011816",
"telephone_number": "315-788-9366",
"fax_number": "315-405-8473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTYRE",
"first_name": "DALE",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-17",
"last_updated": "2010-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "20 047506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.