Healthcare Provider Details

I. General information

NPI: 1528380037
Provider Name (Legal Business Name): MELISSA DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 STATE SCHOOL RD
ALBION NY
14411-9348
US

IV. Provider business mailing address

3595 STATE SCHOOL RD
ALBION NY
14411-9348
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-5511
  • Fax:
Mailing address:
  • Phone: 585-589-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046167
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: