Provider Demographics
NPI:1720548019
Name:IRONDEQUOIT PHARMACY, LLC
Entity Type:Organization
Organization Name:IRONDEQUOIT PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-269-9720
Mailing Address - Street 1:376 MOUNT AIRY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-2126
Mailing Address - Country:US
Mailing Address - Phone:585-340-6440
Mailing Address - Fax:
Practice Address - Street 1:545 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3154
Practice Address - Country:US
Practice Address - Phone:585-340-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy