Healthcare Provider Details

I. General information

NPI: 1336256155
Provider Name (Legal Business Name): UNIVERSITY OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 LAC DE VILLE BLVD
ROCHESTER NY
14618-5600
US

IV. Provider business mailing address

5901 LAC DE VILLE BLVD
ROCHESTER NY
14618-5600
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-3164
  • Fax: 585-271-1811
Mailing address:
  • Phone: 585-271-3164
  • Fax: 585-271-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027777
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON SMITH
Title or Position: ASSOCIATE DIRECTOR OF OUTPATIENT PH
Credential: RPH
Phone: 585-785-5193