Provider Demographics
NPI:1023773363
Name:PESTA, DARRELL M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:M
Last Name:PESTA
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 1:3595 STATE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9348
Mailing Address - Country:US
Mailing Address - Phone:585-589-5511
Mailing Address - Fax:
Practice Address - Street 1:3595 STATE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9348
Practice Address - Country:US
Practice Address - Phone:585-589-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI060387-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist