Healthcare Provider Details

I. General information

NPI: 1578742342
Provider Name (Legal Business Name): DEBORAH LYNN MAZZA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 MOHAWK ST
UTICA NY
13501-3136
US

IV. Provider business mailing address

1033 MOHAWK ST
UTICA NY
13501-3136
US

V. Phone/Fax

Practice location:
  • Phone: 315-733-3604
  • Fax: 315-733-3671
Mailing address:
  • Phone: 315-733-3604
  • Fax: 315-733-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038767-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: