Healthcare Provider Details

I. General information

NPI: 1063302248
Provider Name (Legal Business Name): GRETA STAUBLY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

IV. Provider business mailing address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number071729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: