Provider Demographics
NPI:1336240118
Name:ROOS, JERRI LEMM (RPH)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:LEMM
Last Name:ROOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JERRI
Other - Middle Name:ANN
Other - Last Name:LEMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6 TERRACE HILL DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-9500
Mailing Address - Country:US
Mailing Address - Phone:585-586-1803
Mailing Address - Fax:
Practice Address - Street 1:1050 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2908
Practice Address - Country:US
Practice Address - Phone:585-216-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist