=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023105376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCHESTER GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 04/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1415 PORTLAND AVE STE 125
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14621-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-922-3970
-----------------------------------------------------
Fax | 585-922-3568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1415 PORTLAND AVE SUITE 125
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14621-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-922-3970
-----------------------------------------------------
Fax | 585-922-3568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VICE PRESIDENT, FINANCE
-----------------------------------------------------
Name | PAULA TINCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-922-1223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 009368
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------