MEDICARE: SIMONE VANESSA BLACKMAN PHARM.D

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	048603	NY

General Provider Information

NPI Number	:	1982815031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE VANESSA BLACKMAN PHARM.D

Provider Business Mailing Address
First Line	:	71 BEDFORDSHIRE DR
Second Line	:
City	:	HENRIETTA
State	:	NY
Zip	:	14467-9372
Country	:	US
Telephone Number	:	585-359-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 PORTLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-5117
Country	:	US
Telephone Number	:	585-266-5930
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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