Provider Demographics
NPI:1376931584
Name:ZOLLEG, STEPHEN
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ZOLLEG
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 1:600 GREECE RIDGE CENTER DR
Mailing Address - Street 2:TARGET PHARMACY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2825
Mailing Address - Country:US
Mailing Address - Phone:585-225-1597
Mailing Address - Fax:585-957-7292
Practice Address - Street 1:600 GREECE RIDGE CENTER DR
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2825
Practice Address - Country:US
Practice Address - Phone:585-225-1597
Practice Address - Fax:585-957-7292
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician