Healthcare Provider Details

I. General information

NPI: 1073836128
Provider Name (Legal Business Name): KATHY MILITELLO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 W TAFT RD
LIVERPOOL NY
13088-4811
US

IV. Provider business mailing address

4979 W TAFT RD
LIVERPOOL NY
13088-4811
US

V. Phone/Fax

Practice location:
  • Phone: 315-457-4570
  • Fax: 315-451-5744
Mailing address:
  • Phone: 315-457-4570
  • Fax: 315-451-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: