Provider Demographics
NPI:1619033735
Name:PASSER, JERALD LAWRENCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERALD
Middle Name:LAWRENCE
Last Name:PASSER
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:PO BOX 668
Mailing Address - Street 2:(5164 BLUE HERON WAY)
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-0668
Mailing Address - Country:US
Mailing Address - Phone:585-229-5474
Mailing Address - Fax:
Practice Address - Street 1:2833 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1632
Practice Address - Country:US
Practice Address - Phone:585-723-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist