MEDICARE: JENNIFER DYS 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	049716	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049716	OTHER	NY	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1861660995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DYS RPH

Provider Business Mailing Address
First Line	:	1500 BROOKS AVE
Second Line	:	ATTN: PHARMACY OFFICE
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3512
Country	:	US
Telephone Number	:	585-239-2020
Fax Number	:	585-239-2015

Provider Business Practice Location Address
First Line	:	6660 FOURTH SECTION RD
Second Line	:	ATTN: PHARMACY MANAGER
City	:	BROCKPORT
State	:	NY
Zip	:	14420-2448
Country	:	US
Telephone Number	:	585-637-7691
Fax Number	:	585-637-7848

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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