=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023570918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSSA C MEYER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2019
-----------------------------------------------------
Last Update Date | 01/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 N CENTER ST
-----------------------------------------------------
City | PERRY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14530-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-237-3113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2784 DUNHAM RD
-----------------------------------------------------
City | VARYSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14167-9736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-949-9240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 066917
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------