Provider Demographics
NPI:1922320308
Name:FOLLENDORF, WILLIAM EDWARD (BS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:FOLLENDORF
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1343
Mailing Address - Country:US
Mailing Address - Phone:585-786-2100
Mailing Address - Fax:585-786-3217
Practice Address - Street 1:91 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1343
Practice Address - Country:US
Practice Address - Phone:585-786-2100
Practice Address - Fax:585-786-3217
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019193-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00485483Medicaid
NY1881757920OtherNATIONAL PROVIDER NUMBER FOR REXALL DRUG, INC.
NY3355218OtherNCPDP
NY0808680001Medicare NSC