Provider Demographics
NPI:1063546760
Name:FIEDERER, JOCELYN R (RPH)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:R
Last Name:FIEDERER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CHARLTON RD
Mailing Address - Street 2:93 CHARLTON RD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3837
Mailing Address - Country:US
Mailing Address - Phone:585-544-2714
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE. BOX 638
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-275-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist