Healthcare Provider Details

I. General information

NPI: 1639394042
Provider Name (Legal Business Name): JAMES FRANCIS ROVEGNO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHAUTAUQUA AVE
LAKEWOOD NY
14750-1241
US

IV. Provider business mailing address

29 PECK AVE PO BOX 389
CHAUTAUQUA NY
14722-0389
US

V. Phone/Fax

Practice location:
  • Phone: 716-763-0016
  • Fax: 716-763-0076
Mailing address:
  • Phone: 716-357-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027298-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: