Provider Demographics
NPI:1447687983
Name:RIESDORPH, JONATHON BROOK (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:BROOK
Last Name:RIESDORPH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3007
Mailing Address - Country:US
Mailing Address - Phone:585-210-4701
Mailing Address - Fax:585-210-4707
Practice Address - Street 1:665 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3007
Practice Address - Country:US
Practice Address - Phone:585-210-4701
Practice Address - Fax:585-210-4707
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI058079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist