Healthcare Provider Details

I. General information

NPI: 1093784738
Provider Name (Legal Business Name): WEGMANS FOOD MARKETS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WALDEN AVE ATTN: PHARMACY MANAGER
CHEEKTOWAGA NY
14225-5113
US

IV. Provider business mailing address

1500 BROOKS AVE ATTN: PHARMACY OFFICE
ROCHESTER NY
14624-3512
US

V. Phone/Fax

Practice location:
  • Phone: 716-681-0091
  • Fax: 716-686-0638
Mailing address:
  • Phone: 585-239-2020
  • Fax: 585-239-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number021109
License Number StateNY

VIII. Authorized Official

Name: JOHN B CARLO
Title or Position: DIRECTOR OF MANAGED CARE
Credential: RPH
Phone: 585-239-2020