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NPI Code Detail

MEDICARE: MR. GARY WAYNE WILLISON RPH

MEDICARE: MR. GARY WAYNE WILLISON RPH
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
1183500000XPharmacist032064-INY
2183500000XPharmacistRP442542PA

General Provider Information

NPI Number : 1932423282
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY WAYNE WILLISON RPH
Provider Business Mailing Address
First Line : 1388 CALKINS RD
Second Line :
City : PITTSFORD
State : NY
Zip : 14534-2521
Country : US
Telephone Number : 585-334-8323
Fax Number :
Provider Business Practice Location Address
First Line : 2665 E HENRIETTA RD
Second Line :
City : HENRIETTA
State : NY
Zip : 14467-9370
Country : US
Telephone Number : 585-359-3250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2010
Last Update Date : 03/16/2010

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