Healthcare Provider Details

I. General information

NPI: 1568667343
Provider Name (Legal Business Name): METCARERX BROWN SQUARE PHARMACEUTICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
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: 585-235-2372
Mailing address:
  • Phone: 585-254-6480
  • Fax: 585-235-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028295
License Number StateNY

VIII. Authorized Official

Name: MR. CHARLES SEIDE
Title or Position: SENIOR VP
Credential:
Phone: 973-857-9800