Healthcare Provider Details

I. General information

NPI: 1538349394
Provider Name (Legal Business Name): GEOFFREY C STALEY PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STUYVESANT MNR
GENESEO NY
14454-1102
US

IV. Provider business mailing address

32 STUYVESANT MNR
GENESEO NY
14454-1102
US

V. Phone/Fax

Practice location:
  • Phone: 585-243-5041
  • Fax: 585-335-3392
Mailing address:
  • Phone: 585-243-5041
  • Fax: 585-335-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: