Provider Demographics
NPI:1871761767
Name:WIDRICK, CATHERINE ANN (RPH)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:WIDRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROOKS AVE
Mailing Address - Street 2:ATTN: PHARMACY MANAGER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3512
Mailing Address - Country:US
Mailing Address - Phone:585-239-2020
Mailing Address - Fax:585-239-2015
Practice Address - Street 1:4979 W TAFT RD
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4811
Practice Address - Country:US
Practice Address - Phone:315-457-0700
Practice Address - Fax:315-451-5744
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043850OtherPHARMACIST LICENSE