Healthcare Provider Details

I. General information

NPI: 1376694224
Provider Name (Legal Business Name): THE CHAUTAUQUA CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PINE ST
SOUTH DAYTON NY
14138-0290
US

IV. Provider business mailing address

P.O. BOX 290 303 PINE ST
SOUTH DAYTON NY
14138-0290
US

V. Phone/Fax

Practice location:
  • Phone: 716-988-3410
  • Fax: 716-988-3720
Mailing address:
  • Phone: 716-988-3410
  • Fax: 716-988-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040701
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL C PEASE
Title or Position: CEO
Credential:
Phone: 716-363-6890