Provider Demographics
NPI:1629240726
Name:MARCHITELLI, DAVID JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MARCHITELLI
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 1:1500 BROOKS AVE
Mailing Address - Street 2:ATTN: PHARMACY OFFICE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3512
Mailing Address - Country:US
Mailing Address - Phone:585-239-2020
Mailing Address - Fax:585-239-2015
Practice Address - Street 1:650 HYLAN DR
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4253
Practice Address - Country:US
Practice Address - Phone:585-424-7350
Practice Address - Fax:585-424-7540
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044045OtherPHARMACIST LICENSE