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General NPI Number Information
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NPI Number | 1104545698
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Entity Type | Individual
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Provider Name | MARISA TOMMARELLO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 2515 ERIE BLVD E
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City | SYRACUSE
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State | NY
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Zip | 13224-1109
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Country | US
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Telephone | 315-449-2314
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Fax |
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Provider Business Mailing Address
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Address Line | 3440 VAN WIE DR E
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-8910
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Country | US
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Telephone | 315-440-3693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 069429
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License Number State | NY
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