Provider Demographics
NPI:1366750952
Name:TAY, DAVID JOHN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:TAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 WESTMINSTER RD APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2850
Mailing Address - Country:US
Mailing Address - Phone:217-766-8975
Mailing Address - Fax:
Practice Address - Street 1:430 SPENCERPORT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5219
Practice Address - Country:US
Practice Address - Phone:585-247-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI054983-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist