Individual
CORY VANDEUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
300 HAMILTON ST, GENEVA, NY 14456-2913
(315) 781-7737
(315) 781-1346
Mailing address
300 HAMILTON ST, GENEVA, NY 14456-2913
(315) 781-7737
(315) 781-1346
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
052615
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052615
PHARMACIST LICENSE #
NY
Enumeration date
03/11/2010
Last updated
03/11/2010
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