Organization
CRM-CANANDAIGUA LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF HETRICK (CHIEF OPERATING OFFICER)
(716) 830-2518
Entity
Organization
Contact information
Practice address
75 VICTOR HEIGHTS PKWY STE C, VICTOR, NY 14564-8926
(585) 337-4300
(585) 396-7264
Mailing address
75 VICTOR HEIGHTS PKWY STE C, VICTOR, NY 14564-8926
(585) 337-4300
(585) 396-7264
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
031319
NY
333600000X
Pharmacy
PH 29053
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03467627
—
NY
01
—
2136804
PK
—
Enumeration date
04/18/2012
Last updated
01/27/2021
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