Provider Demographics
NPI:1366030702
Name:LACREGO, AUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:LACREGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N WINTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1936
Mailing Address - Country:US
Mailing Address - Phone:585-288-4422
Mailing Address - Fax:
Practice Address - Street 1:185 N WINTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1936
Practice Address - Country:US
Practice Address - Phone:585-288-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist