Provider Demographics
NPI:1750637294
Name:D'AMIGO, PETER MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:D'AMIGO
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 1:4287 GENESEE VALLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9434
Mailing Address - Country:US
Mailing Address - Phone:585-243-9020
Mailing Address - Fax:585-243-9516
Practice Address - Street 1:4287 GENESEE VALLEY PLZ
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9434
Practice Address - Country:US
Practice Address - Phone:585-243-9020
Practice Address - Fax:585-243-9516
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist