=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033432117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN ANTHONY CONIGLIO R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2010
-----------------------------------------------------
Last Update Date | 03/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 AYRSHIRE LN
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14467-9382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-486-4640
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 AYRSHIRE LN
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14467-9382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-278-5017
-----------------------------------------------------
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 | 026966
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S016329
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------