Healthcare Provider Details

I. General information

NPI: 1851614374
Provider Name (Legal Business Name): BECKY B PETRONIO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8378 SENECA TURNPIKE
NEW HARTFORD NY
13413-4956
US

IV. Provider business mailing address

8378 SENECA TPKE
NEW HARTFORD NY
13413-4956
US

V. Phone/Fax

Practice location:
  • Phone: 800-627-4455
  • Fax: 315-624-7982
Mailing address:
  • Phone: 800-627-4455
  • Fax: 315-624-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number037362-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number2194
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: