Healthcare Provider Details

I. General information

NPI: 1649707647
Provider Name (Legal Business Name): CDSRX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/21/2022
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GEDDES STREET EXT
HOLLEY NY
14470-1122
US

IV. Provider business mailing address

3 GEDDES STREET EXT
HOLLEY NY
14470-1122
US

V. Phone/Fax

Practice location:
  • Phone: 585-638-5499
  • Fax: 585-638-6149
Mailing address:
  • Phone: 585-638-5499
  • Fax: 585-638-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number033281
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LUCAS J MILLER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 585-638-5499