MEDICARE: MRS. CHRISTINE HAACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	030618-1	NY

General Provider Information

NPI Number	:	1063699874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE HAACK

Provider Business Mailing Address
First Line	:	1900 S.CLINTON AVE.
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 S CLINTON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5621
Country	:	US
Telephone Number	:	585-461-3770
Fax Number	:	585-271-1606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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