Individual
ADAM DERUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
500 S MEADOW DRIVE, ITHACA, NY 14850-5317
(607) 277-1772
(607) 277-5890
Mailing address
500 S MEADOW DRIVE, ITHACA, NY 14850-5317
(607) 277-1772
(607) 277-5890
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
052853
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052853
PHARMACIST LICENSE #
NY
Enumeration date
03/05/2010
Last updated
03/05/2010
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