Provider Demographics
NPI:1407032907
Name:AUSTIN, DALE HUGH (RPH)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:HUGH
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 ANGELA WAY
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9660
Mailing Address - Country:US
Mailing Address - Phone:585-394-7911
Mailing Address - Fax:
Practice Address - Street 1:91 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2220
Practice Address - Country:US
Practice Address - Phone:585-394-2987
Practice Address - Fax:585-394-1952
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist