Healthcare Provider Details

I. General information

NPI: 1154504108
Provider Name (Legal Business Name): LINDA CASTRELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 DOWNER ST
BALDWINSVILLE NY
13027-2800
US

IV. Provider business mailing address

113 DOWNER ST
BALDWINSVILLE NY
13027-2800
US

V. Phone/Fax

Practice location:
  • Phone: 315-635-8821
  • Fax:
Mailing address:
  • Phone: 315-635-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: