Active NPI
David Thide
- Pharmacist
- Rochester, NY
National Provider Identifier
1255512828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 040784
- Practice address
- 1659 Penfield Rd
Rochester, NY 14625-2549 - Phone
- (585) 419-0560
- NPI assigned
- Nov 23, 2007
- Last updated
- Feb 22, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 040784 | NY | Primary |
Addresses
Primary practice location
1659 Penfield Rd
Rochester, NY 14625-2549
Mailing address
1659 Penfield Rd
Rochester, NY 14625-2549
Phone (585) 419-0560
Other practice location 1
720 E. Ridge Road
Rochester, NY 14617-6003
Phone (585) 266-8994
Other practice location 2
1490 Lake Ave
Rochester, NY 14615-3041
Phone (585) 458-2260
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040784 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1659 Penfield Rd
Rochester, NY 14625
Phone (585) 419-0560
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": "1195776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613952000000",
"number": "1255512828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1659 PENFIELD RD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146252549",
"telephone_number": "585-419-0560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1659 PENFIELD RD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146252549",
"telephone_number": "585-419-0560"
}
],
"practiceLocations": [
{
"address_1": "720 E. Ridge Road",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146176003",
"country_code": "US",
"telephone_number": "585-266-8994",
"fax_number": "585-266-9016",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1490 Lake Ave",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146153041",
"country_code": "US",
"telephone_number": "585-458-2260",
"fax_number": "585-719-9833",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THIDE",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-23",
"last_updated": "2021-02-22",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "040784",
"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 Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.