Provider Demographics
NPI:1790769883
Name:WEGMANS FOOD MARKETS, INC
Entity Type:Organization
Organization Name:WEGMANS FOOD MARKETS, INC
Other - Org Name:WEGMANS PHARMACY #029
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LENHARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-239-2001
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:14624-3512
Mailing Address - Country:US
Mailing Address - Phone:585-237-9435
Mailing Address - Fax:585-239-2015
Practice Address - Street 1:700 1ST NORTH ST
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2180
Practice Address - Country:US
Practice Address - Phone:315-476-9954
Practice Address - Fax:315-471-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019729333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00571797Medicaid
NY0639890019Medicare NSC