Provider Demographics
NPI:1649454612
Name:DAUM, TRICIA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:MARIE
Last Name:DAUM
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 1:170 EASTERN BLVD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2218
Mailing Address - Country:US
Mailing Address - Phone:585-394-2987
Mailing Address - Fax:585-394-1952
Practice Address - Street 1:170 EASTERN BLVD
Practice Address - Street 2:RITE AID
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2218
Practice Address - Country:US
Practice Address - Phone:585-394-2987
Practice Address - Fax:585-394-1952
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01129193Medicaid