MEDICARE: MR. JAMES MITCHELL SANNES PHARMACIST

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	032135	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032135	OTHER	NY	PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1346424421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MITCHELL SANNES PHARMACIST

Provider Business Mailing Address
First Line	:	133 DORCHESTER RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14213-1444
Country	:	US
Telephone Number	:	716-574-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 S MAIN ST
Second Line	:
City	:	MEDINA
State	:	NY
Zip	:	14103-9779
Country	:	US
Telephone Number	:	158-579-8198
Fax Number	:

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	03/01/2010

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