Organization
PINE PHARMACEY AT TWELVE CORNERS LLC
Active
Other names
Pine Pharmacey at Twelve Corners LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSE MUTO (OWNER)
(716) 628-4986
Entity
Organization
Contact information
Practice address
1832 MONROE AVE, ROCHESTER, NY 14618-1922
(585) 244-8600
(585) 697-3490
Mailing address
1832 MONROE AVE, ROCHESTER, NY 14618-1922
(585) 244-8600
(585) 697-3490
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
033859
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154707
PK
—
Enumeration date
02/15/2008
Last updated
10/19/2015
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