Provider Demographics
NPI:1104139146
Name:IMES, JESSE MICHAEL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:MICHAEL
Last Name:IMES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1737
Mailing Address - Country:US
Mailing Address - Phone:513-673-7935
Mailing Address - Fax:
Practice Address - Street 1:2626 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1737
Practice Address - Country:US
Practice Address - Phone:513-673-7935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist