Provider Demographics
NPI:1598088429
Name:DADIZ, ARVIN CORTEZ (BS)
Entity Type:Individual
Prefix:
First Name:ARVIN
Middle Name:CORTEZ
Last Name:DADIZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ROLLINS XING
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2768
Mailing Address - Country:US
Mailing Address - Phone:585-383-3604
Mailing Address - Fax:
Practice Address - Street 1:525 SPENCERPORT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4815
Practice Address - Country:US
Practice Address - Phone:585-247-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist