Healthcare Provider Details

I. General information

NPI: 1255847489
Provider Name (Legal Business Name): ROCHESTER GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE BLDG 1
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

1425 PORTLAND AVE BLDG 1
ROCHESTER NY
14621-3011
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-4973
  • Fax:
Mailing address:
  • Phone: 585-338-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RENEE PRICE
Title or Position: BILLING & COMPLIANCE SPECIALIST
Credential:
Phone: 585-922-3970