Provider Demographics
NPI:1962649376
Name:EDD, JILL WALPOLE (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:WALPOLE
Last Name:EDD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OLIVIA DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4308
Mailing Address - Country:US
Mailing Address - Phone:585-227-7628
Mailing Address - Fax:
Practice Address - Street 1:878 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3049
Practice Address - Country:US
Practice Address - Phone:585-723-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist