Healthcare Provider Details

I. General information

NPI: 1124270400
Provider Name (Legal Business Name): CAROLYN DORAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7519 OSWEGO RD ATTN: PHARMACY MANAGER
LIVERPOOL NY
13090-2927
US

IV. Provider business mailing address

1500 BROOKS AVE ATTENTION PHARMACY OFFICE
ROCHESTER NY
14624-3512
US

V. Phone/Fax

Practice location:
  • Phone: 315-622-2100
  • Fax: 315-622-9900
Mailing address:
  • Phone: 585-279-4355
  • Fax: 585-239-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: