MEDICARE: DEXTER PRESCRIPTION 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	333600000X	Pharmacy	017951	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801904438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEXTER PRESCRIPTION CENTER INC

Provider Business Mailing Address
First Line	:	1453 JEFFERSON AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14208
Country	:	US
Telephone Number	:	716-885-7878
Fax Number	:	716-885-4412

Provider Business Practice Location Address
First Line	:	1453 JEFFERSON AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14208
Country	:	US
Telephone Number	:	716-885-7878
Fax Number	:	716-885-4412

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL L REWHART
Credential	:	RPH
Telephone Number	:	716-885-7878

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/07/2020

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