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General NPI Number Information
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NPI Number | 1588986467
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Entity Type | Individual
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Provider Name | JOHN DMYTRENKO
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Gender | Male
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 990 ROUTE 5 AND 20
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City | GENEVA
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State | NY
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Zip | 14456-9543
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Country | US
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Telephone | 315-781-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 3487 BRICK CHURCH RD
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City | UNION SPRINGS
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State | NY
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Zip | 13160
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Country | US
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Telephone | 315-364-7955
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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 | 053612
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License Number State | NY
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