MEDICARE: BRADLEY E CHASE RPH

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	046824	NY

General Provider Information

NPI Number	:	1679896849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY E CHASE RPH

Provider Business Mailing Address
First Line	:	700 ELMRIDGE CENTER DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-3465
Country	:	US
Telephone Number	:	585-723-3406
Fax Number	:	585-723-5992

Provider Business Practice Location Address
First Line	:	700 ELMRIDGE CENTER DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-3465
Country	:	US
Telephone Number	:	585-723-3406
Fax Number	:	585-723-5992

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

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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