MEDICARE: EMILY ALYSSA LE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03438460	OH
2	183500000X	Pharmacist	065478	NY

General Provider Information

NPI Number	:	1871124842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ALYSSA LE PHARMD

Provider Business Mailing Address
First Line	:	715 MARKET ST
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-2560
Country	:	US
Telephone Number	:	716-572-8816
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 LOCKPORT ST
Second Line	:
City	:	YOUNGSTOWN
State	:	NY
Zip	:	14174-1008
Country	:	US
Telephone Number	:	716-745-3313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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