Provider Demographics
NPI:1093778284
Name:ALTAVELA, JEANETTE LEIGH (RPH, PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:LEIGH
Last Name:ALTAVELA
Suffix:
Gender:F
Credentials:RPH, PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3529
Mailing Address - Country:US
Mailing Address - Phone:585-265-4578
Mailing Address - Fax:
Practice Address - Street 1:60 CARLSON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1021
Practice Address - Country:US
Practice Address - Phone:585-922-1548
Practice Address - Fax:585-922-1524
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy