Healthcare Provider Details

I. General information

NPI: 1275932238
Provider Name (Legal Business Name): MARIA MEOLA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S MAIN STREET
NEW BERLIN NY
13411
US

IV. Provider business mailing address

12 S MAIN STREET
NEW BERLIN NY
13411
US

V. Phone/Fax

Practice location:
  • Phone: 607-847-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059705
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: