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General NPI Number Information
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NPI Number | 1104095793
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Entity Type | Individual
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Provider Name | THOMAS R NETTLES RPH
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Gender | Male
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 3750 MOUNT READ BOULEVARD CVS PHARMACY
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City | ROCHESTER
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State | NY
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Zip | 14616
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Country | US
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Telephone | 585-581-5101
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Fax | 585-581-2646
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Provider Business Mailing Address
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Address Line | 2937 W KENDALL RD
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City | HOLLEY
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State | NY
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Zip | 14470-9519
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Country | US
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Telephone | 585-638-5843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 045260
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License Number State | NY
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