Provider Demographics
NPI:1689657876
Name:WEGMANS FOOD MARKETS, INC.
Entity Type:Organization
Organization Name:WEGMANS FOOD MARKETS, INC.
Other - Org Name:WEGMANS PHARMACY #004
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-429-3902
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
Mailing Address - Country:US
Mailing Address - Phone:585-239-2009
Mailing Address - Fax:585-239-2044
Practice Address - Street 1:851 FAIRPORT RD
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1994
Practice Address - Country:US
Practice Address - Phone:585-586-7922
Practice Address - Fax:585-586-0675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEGMANS FOOD MARKETS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-22
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
NY019709333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00459678Medicaid
NY00459678Medicaid