Provider Demographics
NPI:1659816916
Name:GARNETT PHARMACY
Entity Type:Organization
Organization Name:GARNETT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/ MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-236-4404
Mailing Address - Street 1:2780 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4626
Mailing Address - Country:US
Mailing Address - Phone:585-236-4404
Mailing Address - Fax:585-486-6366
Practice Address - Street 1:2780 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4626
Practice Address - Country:US
Practice Address - Phone:585-236-4404
Practice Address - Fax:585-486-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0351263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167151OtherPK