Healthcare Provider Details

I. General information

NPI: 1326374026
Provider Name (Legal Business Name): NICHOLAS MOZZETTI PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 SANGER AVE
WATERVILLE NY
13480-1122
US

IV. Provider business mailing address

245 OXFORD RD APT 12 F
NEW HARTFORD NY
13413-4300
US

V. Phone/Fax

Practice location:
  • Phone: 315-841-4447
  • Fax:
Mailing address:
  • Phone: 315-534-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: