National Provider Identifier
Isaac G Provo, RPH
Isaac G Provo, RPH is listed in the NPPES registry with a primary specialty of Pharmacist in Newark, NY and a listed phone number of (315) 331-7150.
Profile Overview
- NPI
- 1639340169
- Provider Type
- Individual
- Primary Specialty
- Pharmacist
- Enumeration Date
- March 12, 2008
- Last Updated
- March 12, 2008
Practice Location
- Miller And Finch Streets
- Attn Pharmacy Manager
- Newark, NY 14513
Phone: (315) 331-7150
Mailing Address
- 1500 Brooks Ave
- Attn: Pharmacy Office
- Rochester, NY 14624-3512
Specialties
- Pharmacist (183500000X)
Full Record
- NPI
- 1639340169
- Entity Type
- Individual
- Last Name
- Provo
- First Name
- Isaac
- Middle Name
- G
- Credential
- RPH
- Mailing Street Address
- 1500 Brooks Ave
- Mailing Address Line 2
- Attn: Pharmacy Office
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14624-3512
- Mailing Country
- US
- Mailing Phone
- (585) 239-2020
- Mailing Fax
- (585) 239-2015
- Practice Street Address
- Miller And Finch Streets
- Practice Address Line 2
- Attn Pharmacy Manager
- Practice City
- Newark
- Practice State
- NY
- Practice ZIP Code
- 14513
- Practice Country
- US
- Practice Phone
- (315) 331-7150
- Practice Fax
- (315) 331-8065
- Enumeration Date
- March 12, 2008
- Last Updated
- March 12, 2008
- Sex
- Male
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Pharmacist (183500000X)
- Other Identifiers
- 030985 (NY, Pharmacist License)