Provider Demographics
NPI:1437549920
Name:DENNIE, ELIZABETH KATHERINE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHERINE
Last Name:DENNIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1010
Mailing Address - Country:US
Mailing Address - Phone:585-425-2300
Mailing Address - Fax:585-421-7208
Practice Address - Street 1:7500 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1010
Practice Address - Country:US
Practice Address - Phone:585-425-2300
Practice Address - Fax:585-421-7208
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0919003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy