Healthcare Provider Details

I. General information

NPI: 1801496161
Provider Name (Legal Business Name): DR. GREGORY STATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

IV. Provider business mailing address

41 MONACO DR
ROCHESTER NY
14624-2209
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-1525
  • Fax:
Mailing address:
  • Phone: 585-857-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number067151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: