Healthcare Provider Details

I. General information

NPI: 1336104090
Provider Name (Legal Business Name): AMY SUE HERMAN PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 MAIN STREET ROSENKRANS PHARMACY
MEDINA NY
14103
US

IV. Provider business mailing address

526 MAIN STREET ROSENKRANS PHARMACY
MEDINA NY
14103
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-1650
  • Fax: 585-798-9632
Mailing address:
  • Phone: 585-798-1650
  • Fax: 585-798-9632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: