Provider Demographics
NPI:1386976579
Name:JERGE, GARY F (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:F
Last Name:JERGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 MAPLE RIDGE RD.
Mailing Address - Street 2:TOPS PHARMACY
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1844
Mailing Address - Country:US
Mailing Address - Phone:585-798-1629
Mailing Address - Fax:585-798-1623
Practice Address - Street 1:11200 MAPLE RIDGE RD.
Practice Address - Street 2:TOPS PHARMACY
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1844
Practice Address - Country:US
Practice Address - Phone:585-798-1629
Practice Address - Fax:585-798-1623
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist