Provider Demographics
NPI:1093784738
Name:WEGMANS FOOD MARKETS, INC
Entity Type:Organization
Organization Name:WEGMANS FOOD MARKETS, INC
Other - Org Name:WEGMANS PHARMACY #185
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-239-2020
Mailing Address - Street 1:1500 BROOKS AVE
Mailing Address - Street 2:ATTN: PHARMACY OFFICE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3512
Mailing Address - Country:US
Mailing Address - Phone:585-239-2020
Mailing Address - Fax:585-239-2015
Practice Address - Street 1:2001 WALDEN AVE
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5113
Practice Address - Country:US
Practice Address - Phone:716-681-0091
Practice Address - Fax:716-686-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021109333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01262720Medicaid
NY0639890028Medicare NSC