Provider Demographics
NPI:1326256736
Name:SHORTSLEEVE, EDWARD J (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:SHORTSLEEVE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BROADMOOR TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9391
Mailing Address - Country:US
Mailing Address - Phone:585-421-3682
Mailing Address - Fax:
Practice Address - Street 1:2950 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1643
Practice Address - Country:US
Practice Address - Phone:585-225-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist