MEDICARE: MRS. AMY SUSAN IANNON RPH

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
1	183500000X	Pharmacist	049040	NY

General Provider Information

NPI Number	:	1639354426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY SUSAN IANNON RPH

Provider Business Mailing Address
First Line	:	3049 ROUTE 50 #1
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866
Country	:	US
Telephone Number	:	518-583-3697
Fax Number	:

Provider Business Practice Location Address
First Line	:	3049 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866
Country	:	US
Telephone Number	:	518-583-3697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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