Provider Demographics
NPI:1205041910
Name:WASTOWICZ, DAVID J (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:WASTOWICZ
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:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0411
Mailing Address - Country:US
Mailing Address - Phone:585-582-1260
Mailing Address - Fax:
Practice Address - Street 1:2975 BRIGHTON HENRIETTA TL 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:585-339-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist