Provider Demographics
NPI:1801904438
Name:DEXTER PRESCRIPTION CENTER INC
Entity type:Organization
Organization Name:DEXTER PRESCRIPTION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:REWHART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-885-7878
Mailing Address - Street 1:1453 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208
Mailing Address - Country:US
Mailing Address - Phone:716-885-7878
Mailing Address - Fax:716-885-4412
Practice Address - Street 1:1453 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208
Practice Address - Country:US
Practice Address - Phone:716-885-7878
Practice Address - Fax:716-885-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017951333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00801978Medicaid
NY0864450001Medicare NSC