Provider Demographics
NPI:1275949620
Name:JANESE, JEREMY BRYAN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:BRYAN
Last Name:JANESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N AMERICA DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2225
Mailing Address - Country:US
Mailing Address - Phone:716-675-3784
Mailing Address - Fax:716-675-7777
Practice Address - Street 1:40 N AMERICA DR
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2225
Practice Address - Country:US
Practice Address - Phone:716-675-3784
Practice Address - Fax:716-675-7777
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist