Healthcare Provider Details

I. General information

NPI: 1417285065
Provider Name (Legal Business Name): MATTHEW WOJDYLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 LATTA RD
ROCHESTER NY
14612-3094
US

IV. Provider business mailing address

3177 LATTA RD
ROCHESTER NY
14612-3094
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-6111
  • Fax: 585-723-6289
Mailing address:
  • Phone: 585-225-6111
  • Fax: 585-723-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: