1720250905 NPI number — RACHEL ANNE MONK RPH

Table of content: RACHEL ANNE MONK RPH (NPI 1720250905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720250905 NPI number — RACHEL ANNE MONK RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONK
Provider First Name:
RACHEL
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720250905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7954 BREWERTON RD
Provider Second Line Business Practice Location Address:
ATTN: PHARMACY MANAGER
Provider Business Practice Location Address City Name:
CICERO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13039-9583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-698-6730
Provider Business Practice Location Address Fax Number:
315-698-6798
Provider Enumeration Date:
03/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  049795 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 049795 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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