Healthcare Provider Details

I. General information

NPI: 1598754327
Provider Name (Legal Business Name): FILLMORE & FISHER PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTER STREET
CUBA NY
14727
US

IV. Provider business mailing address

2 CENTER STREET
CUBA NY
14727
US

V. Phone/Fax

Practice location:
  • Phone: 585-968-3111
  • Fax: 585-968-7998
Mailing address:
  • Phone: 585-968-3111
  • Fax: 585-968-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number020318
License Number StateNY

VIII. Authorized Official

Name: MR. RICK L WONDERLING
Title or Position: PRESIDENT
Credential: RPH.
Phone: 585-968-3111