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General NPI Number Information
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NPI Number | 1316550734
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Entity Type | Individual
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Provider Name | RACHEL ALEXIS PROSSER
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Gender | Female
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 522 W ONONDAGA ST
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City | SYRACUSE
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State | NY
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Zip | 13204-3225
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Country | US
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Telephone | 315-475-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 1381 WILLOWDALE DR
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City | MACEDON
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State | NY
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Zip | 14502-9178
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Country | US
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Telephone | 315-651-9302
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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 | 0066219
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License Number State | NY
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