=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114108248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY E OWREN PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 EASTERN BLVD
-----------------------------------------------------
City | CANANDAIGUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14424-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-396-5990
-----------------------------------------------------
Fax | 585-396-1767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5223 SAMMYS WAY
-----------------------------------------------------
City | CANANDAIGUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14424-8251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-905-0708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 050922
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------