Provider Demographics
NPI:1598889164
Name:SACK, SALVATORE ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:ANTHONY
Last Name:SACK
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 1:201 SCOTTSVILLE W HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:W HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9540
Mailing Address - Country:US
Mailing Address - Phone:585-889-3510
Mailing Address - Fax:585-334-5833
Practice Address - Street 1:201 SCOTTSVILLE W HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:W HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9540
Practice Address - Country:US
Practice Address - Phone:585-889-3510
Practice Address - Fax:585-334-5833
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist