Provider Demographics
NPI:1164665691
Name:ROCHESTER REGIONAL HEALTH HOME INFUSION PHARMACY LLC
Entity Type:Organization
Organization Name:ROCHESTER REGIONAL HEALTH HOME INFUSION PHARMACY LLC
Other - Org Name:LIFETIME PHARMACY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-214-1000
Mailing Address - Street 1:330 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3696
Mailing Address - Country:US
Mailing Address - Phone:585-214-1000
Mailing Address - Fax:585-214-1136
Practice Address - Street 1:2975 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2787
Practice Address - Country:US
Practice Address - Phone:585-461-1314
Practice Address - Fax:585-461-1318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESEE REGION HOME CARE ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293413336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6364540001Medicare NSC