Provider Demographics
NPI:1659551844
Name:HAMILTON, GARY RAY (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RAY
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LAKE AVE
Mailing Address - Street 2:PHARMACY DEPT.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-2410
Mailing Address - Country:US
Mailing Address - Phone:585-254-2480
Mailing Address - Fax:585-254-6953
Practice Address - Street 1:710 LAKE AVE
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-2410
Practice Address - Country:US
Practice Address - Phone:585-254-2480
Practice Address - Fax:585-254-6953
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039101OtherPHARMACY
NY01953442OtherPHARMACY