Provider Demographics
NPI:1346424421
Name:SANNES, JAMES MITCHELL (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MITCHELL
Last Name:SANNES
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 1:133 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1444
Mailing Address - Country:US
Mailing Address - Phone:716-574-4565
Mailing Address - Fax:
Practice Address - Street 1:1422 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9779
Practice Address - Country:US
Practice Address - Phone:158-579-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032135OtherPHARMACY LICENSE NUMBER