Individual
MS. ALICE JESSUP DEDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
4900 BROADWAY, DEPEW, NY 14043-3934
(716) 681-4255
(716) 681-7598
Mailing address
45 TUNBRIDGE WALKE, EAST AURORA, NY 14052-2019
(716) 652-1492
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
026482
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00482751
—
NY
Enumeration date
11/08/2007
Last updated
11/08/2007
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