Healthcare Provider Details

I. General information

NPI: 1598889164
Provider Name (Legal Business Name): SALVATORE ANTHONY SACK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SCOTTSVILLE W HENRIETTA RD
W HENRIETTA NY
14586-9540
US

IV. Provider business mailing address

201 SCOTTSVILLE W HENRIETTA RD
W HENRIETTA NY
14586-9540
US

V. Phone/Fax

Practice location:
  • Phone: 585-889-3510
  • Fax: 585-334-5833
Mailing address:
  • Phone: 585-889-3510
  • Fax: 585-334-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: