MEDICARE: THE CHAUTAUQUA CENTER, INC.

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	040701	NY
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1376694224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHAUTAUQUA CENTER, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 290
Second Line	:	303 PINE ST
City	:	SOUTH DAYTON
State	:	NY
Zip	:	14138-0290
Country	:	US
Telephone Number	:	716-988-3410
Fax Number	:	716-988-3720

Provider Business Practice Location Address
First Line	:	303 PINE ST
Second Line	:
City	:	SOUTH DAYTON
State	:	NY
Zip	:	14138-0290
Country	:	US
Telephone Number	:	716-988-3410
Fax Number	:	716-988-3720

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL C PEASE
Credential	:
Telephone Number	:	716-363-6890

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	11/19/2024

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