Healthcare Provider Details

I. General information

NPI: 1306906235
Provider Name (Legal Business Name): KATHLEEN ANN VENTURA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVE
CENTRAL SQUARE NY
13036-9502
US

IV. Provider business mailing address

710 CHURCH RD
BALDWINSVILLE NY
13027-8663
US

V. Phone/Fax

Practice location:
  • Phone: 315-676-2944
  • Fax:
Mailing address:
  • Phone: 315-678-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037662-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: