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General NPI Number Information
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NPI Number | 1205041910
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Entity Type | Individual
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Provider Name | DAVID J WASTOWICZ RPH
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 2975 BRIGHTON HENRIETTA TL RD
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City | ROCHESTER
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State | NY
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Zip | 14623-2787
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Country | US
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Telephone | 585-339-5515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 411
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City | MENDON
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State | NY
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Zip | 14506-0411
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Country | US
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Telephone | 585-582-1260
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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 | 044842
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License Number State | NY
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