=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396456117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENETTE CASEY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2022
-----------------------------------------------------
Last Update Date | 12/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MIRACLE MILE DR
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14623-5851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-602-4350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 WIDGEDON LNDG
-----------------------------------------------------
City | HILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14468-8955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-597-1462
-----------------------------------------------------
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 | 058111
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------