Healthcare Provider Details

I. General information

NPI: 1568815397
Provider Name (Legal Business Name): PATRICK MCCABE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PORTLAND AVE STE 445
ROCHESTER NY
14621-3022
US

IV. Provider business mailing address

1415 PORTLAND AVE STE 445
ROCHESTER NY
14621-3022
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number061777
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number061777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: