Healthcare Provider Details

I. General information

NPI: 1376931584
Provider Name (Legal Business Name): STEPHEN ZOLLEG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GREECE RIDGE CENTER DR TARGET PHARMACY
ROCHESTER NY
14626-2825
US

IV. Provider business mailing address

600 GREECE RIDGE CENTER DR TARGET PHARMACY
ROCHESTER NY
14626-2825
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-1597
  • Fax: 585-957-7292
Mailing address:
  • Phone: 585-225-1597
  • Fax: 585-957-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: