Provider Demographics
NPI:1154720365
Name:BODROG, JONATHAN DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:BODROG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4225
Mailing Address - Country:US
Mailing Address - Phone:585-417-4131
Mailing Address - Fax:585-417-4132
Practice Address - Street 1:1575 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4225
Practice Address - Country:US
Practice Address - Phone:585-417-4131
Practice Address - Fax:585-417-4132
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448690183500000X
NY062886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist