Isaac G Provo, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

030985 Issued in NY

Practice address

Miller and Finch Streets
Attn Pharmacy Manager
Newark, NY 14513

Phone

(315) 331-7150

Fax

(315) 331-8065

NPI assigned

Mar 12, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1639340169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 BROOKS AVE",
            "address_2": "ATTN: PHARMACY OFFICE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146243512",
            "telephone_number": "585-239-2020",
            "fax_number": "585-239-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MILLER AND FINCH STREETS",
            "address_2": "ATTN PHARMACY MANAGER",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "14513",
            "telephone_number": "315-331-7150",
            "fax_number": "315-331-8065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVO",
        "first_name": "ISAAC",
        "middle_name": "G",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-12",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "030985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "030985",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca J Pollack, OTR
• Nivedita P Prabhu, M.D.
• James E Praino, D.D.S.
• Courtney Marie Preston, NP
• Beverly J Provo, GNPC
• Darren Marshall Pynn, R.PH.
• Carol A Quagliata, RN
• Brian Robert Ragne, PHARMD
• Poonam Ramsdell, PA-C
• Lori Jean Randolph, LPN

• Pharmacist in Newark, NY
• Providers in Newark, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.