Healthcare Provider Details

I. General information

NPI: 1811371610
Provider Name (Legal Business Name): DEANNA PHOENIX PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM & CARLTON STREETS, MAIN HOSPITAL ROSWELL PARK CANCER INSTITUTE
BUFFALO NY
14623
US

IV. Provider business mailing address

ROSWELL PARK CANCER INSTITUTE ELM AND CARLTON ST, MAIN HOSPITAL
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-4046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number052927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: