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NPI Code Detail

MEDICARE: MRS. JACQUELINE SUZANNE SKELTON RPH

MEDICARE: MRS. JACQUELINE SUZANNE SKELTON 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
1183500000XPharmacist048669NY

General Provider Information

NPI Number : 1770639627
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE SUZANNE SKELTON RPH
Provider Business Mailing Address
First Line : 30 WIND WAY CIR
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-2465
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3750 MOUNT READ BLVD
Second Line :
City : ROCHESTER
State : NY
Zip : 14616-3436
Country : US
Telephone Number : 585-581-5101
Fax Number : 585-581-2646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 03/14/2022

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