MEDICARE: MR. PETER CHARRON R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	041248-1	NY

General Provider Information

NPI Number	:	1154508844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER CHARRON R.PH.

Provider Business Mailing Address
First Line	:	18 BITTERSWEET RD
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 PARK AVE.
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-3233
Country	:	US
Telephone Number	:	585-241-2312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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