Provider Demographics
NPI:1952613499
Name:WADE, NATHANIEL JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:JAMES
Last Name:WADE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:156 WEST AVE
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1229
Mailing Address - Country:US
Mailing Address - Phone:585-395-6043
Mailing Address - Fax:585-395-6022
Practice Address - Street 1:156 WEST AVE
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1229
Practice Address - Country:US
Practice Address - Phone:585-395-6043
Practice Address - Fax:585-395-6022
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20 054637OtherSTATE LICENSE