Provider Demographics
NPI:1386973717
Name:UNIVERSITY OF ROCHESTER
Entity type:Organization
Organization Name:UNIVERSITY OF ROCHESTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-275-9572
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:ROOM 3-5022
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-6301
Mailing Address - Fax:585-506-0367
Practice Address - Street 1:601 ELMWOOD AVE # 638
Practice Address - Street 2:ROOM 3-5022
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-6301
Practice Address - Fax:585-506-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0227673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02976534Medicaid
3363493OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3363493OtherNCPDP PROVIDER IDENTIFICATION NUMBER