Healthcare Provider Details

I. General information

NPI: 1619291655
Provider Name (Legal Business Name): EDWARD ROOKE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 ONONDAGA BLVD
SYRACUSE NY
13219-3304
US

IV. Provider business mailing address

4722 ONONDAGA BLVD
SYRACUSE NY
13219-3304
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-6694
  • Fax: 315-478-1680
Mailing address:
  • Phone: 315-478-6694
  • Fax: 315-478-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number031949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: