Provider Demographics
NPI:1710506266
Name:NITCHE, LEA TERESE
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:TERESE
Last Name:NITCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 JACKIE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3612
Mailing Address - Country:US
Mailing Address - Phone:585-905-8276
Mailing Address - Fax:
Practice Address - Street 1:1455 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3000
Practice Address - Country:US
Practice Address - Phone:585-254-4670
Practice Address - Fax:585-254-1022
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist