Provider Demographics
NPI:1598754327
Name:FILLMORE & FISHER PHARMACY, INC
Entity Type:Organization
Organization Name:FILLMORE & FISHER PHARMACY, INC
Other - Org Name:CUBA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WONDERLING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-968-3111
Mailing Address - Street 1:2 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727
Mailing Address - Country:US
Mailing Address - Phone:585-968-3111
Mailing Address - Fax:585-968-7998
Practice Address - Street 1:2 CENTER STREET
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727
Practice Address - Country:US
Practice Address - Phone:585-968-3111
Practice Address - Fax:585-968-7998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FILLMORE FISHER PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-14
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020318332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01146478Medicaid
NY0250770002Medicare NSC
NY0250770002Medicare ID - Type Unspecified