Provider Demographics
NPI:1972537074
Name:WILLOME, DAVID ARTHUR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ARTHUR
Last Name:WILLOME
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 1:100 CITY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1308
Mailing Address - Country:US
Mailing Address - Phone:585-248-8973
Mailing Address - Fax:
Practice Address - Street 1:800 CARTER ST
Practice Address - Street 2:ATTENTION PHARMACY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2604
Practice Address - Country:US
Practice Address - Phone:585-338-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020-34611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist