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NPI Code Detail

MEDICARE: STEPHANIE BLANCHE MUSTICO PHARMD

MEDICARE: STEPHANIE BLANCHE MUSTICO PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051079NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1051079OTHERNYPHARMACIST LICENSE

General Provider Information

NPI Number : 1194997221
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE BLANCHE MUSTICO PHARMD
Provider Business Mailing Address
First Line : 1500 BROOKS AVE
Second Line : ATTN: PHARMACY MANAGER
City : ROCHESTER
State : NY
Zip : 14624-3512
Country : US
Telephone Number : 585-239-2020
Fax Number : 585-239-2015
Provider Business Practice Location Address
First Line : 1100 CLEMENS CENTER PKWY
Second Line : ATTN: PHARMACY MANAGER
City : ELMIRA
State : NY
Zip : 14901-1563
Country : US
Telephone Number : 607-737-5090
Fax Number : 637-737-5067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2008
Last Update Date : 04/21/2017

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