Healthcare Provider Details

I. General information

NPI: 1124209218
Provider Name (Legal Business Name): PATRICK MICHAEL MCCULLOR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2007
Last Update Date: 11/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E MAIN ST
BATAVIA NY
14020-2827
US

IV. Provider business mailing address

601 E MAIN ST
BATAVIA NY
14020-2827
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-5662
  • Fax: 585-343-7480
Mailing address:
  • Phone: 585-343-5662
  • Fax: 585-343-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: