Provider Demographics
NPI:1588497457
Name:EADIE, JOHN M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:EADIE
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 1:102 COURT ST APT 211
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604
Mailing Address - Country:US
Mailing Address - Phone:585-469-2963
Mailing Address - Fax:
Practice Address - Street 1:2100 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2408
Practice Address - Country:US
Practice Address - Phone:585-461-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist