Provider Demographics
NPI:1518004027
Name:SIDNEY HILLMAN HEALTH CENTER OF ROCHESTER
Entity Type:Organization
Organization Name:SIDNEY HILLMAN HEALTH CENTER OF ROCHESTER
Other - Org Name:SIDNEY HILLMAN HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STERLING
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-473-2555
Mailing Address - Street 1:750 EAST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2100
Mailing Address - Country:US
Mailing Address - Phone:585-473-2555
Mailing Address - Fax:585-242-7580
Practice Address - Street 1:750 EAST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2100
Practice Address - Country:US
Practice Address - Phone:585-473-2555
Practice Address - Fax:585-242-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011958OtherSTATE LICENSE NUMBER
NY3343667OtherNABP#
NY3343667OtherNABP#
NY3343667OtherNABP#