Healthcare Provider Details

I. General information

NPI: 1043533375
Provider Name (Legal Business Name): HMB PHARMACY MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAKE AVE
ROCHESTER NY
14608-1017
US

IV. Provider business mailing address

322 LAKE AVE
ROCHESTER NY
14608-1017
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-6480
  • Fax: 585-672-1737
Mailing address:
  • Phone: 585-254-6480
  • Fax: 585-672-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029864
License Number StateNY

VIII. Authorized Official

Name: RAJ SHAH
Title or Position: COO
Credential:
Phone: 732-318-9628