Healthcare Provider Details

I. General information

NPI: 1316427438
Provider Name (Legal Business Name): EBNE SAFI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST
JAMESTOWN NY
14701-6633
US

IV. Provider business mailing address

1987 D ANGELO DR
GENESEO NY
14454-9703
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-2650
  • Fax:
Mailing address:
  • Phone: 631-579-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: