Active NPI
Jonathan David Bodrog, PHARMD
- Pharmacist
- Rochester, NY
National Provider Identifier
1154720365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 062886
- Practice address
- 1575 Mount Hope Ave
Rochester, NY 14620-4225 - Phone
- (585) 417-4131
- Fax
- (585) 417-4132
- NPI assigned
- Aug 14, 2014
- Last updated
- Sep 13, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP448690 | PA | |
| Pharmacist | 183500000X | 062886 | NY | Primary |
Addresses
Primary practice location
1575 Mount Hope Ave
Rochester, NY 14620-4225
Mailing address
1575 Mount Hope Ave
Rochester, NY 14620-4225
Phone (585) 417-4131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062886 | NY | MD | Pharmacist |
| RP448690 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Thrift Drug Inc | Past | Accepting new patients |
Locations
1575 Mount Hope Ave
Rochester, NY 14620
Phone (585) 417-4131
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568332800000",
"number": "1154720365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 MOUNT HOPE AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146204225",
"telephone_number": "585-417-4131",
"fax_number": "585-417-4132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 MOUNT HOPE AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146204225",
"telephone_number": "585-417-4131",
"fax_number": "585-417-4132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODROG",
"first_name": "JONATHAN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-14",
"last_updated": "2019-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP448690",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "062886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.