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General NPI Number Information
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NPI Number | 1417022526
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Entity Type | Organization
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Legal Business Name | PARK RIDGE APOTHECARY, INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 89 GENESEE ST
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City | ROCHESTER
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State | NY
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Zip | 14611-3201
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Country | US
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Telephone | 585-368-3930
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Fax | 585-368-3933
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Provider Business Mailing Address
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Address Line | 89 GENESEE ST
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City | ROCHESTER
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State | NY
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Zip | 14611-3201
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Country | US
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Telephone | 585-368-3930
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Fax | 585-368-3933
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT CFO
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Name | MR. WARREN HERN
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Credential |
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Telephone | 585-368-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 021849
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License Number State | NY
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