Provider Demographics
NPI:1073836128
Name:MILITELLO, KATHY (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MILITELLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 W TAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4811
Mailing Address - Country:US
Mailing Address - Phone:315-457-4570
Mailing Address - Fax:315-451-5744
Practice Address - Street 1:4979 W TAFT RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4811
Practice Address - Country:US
Practice Address - Phone:315-457-4570
Practice Address - Fax:315-451-5744
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044475OtherPHARMACIST