Provider Demographics
NPI:1073845913
Name:GADOMSKI, KELLY (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GADOMSKI
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 1:922 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1137
Mailing Address - Country:US
Mailing Address - Phone:315-492-1964
Mailing Address - Fax:315-469-9744
Practice Address - Street 1:922 SPENCER ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204
Practice Address - Country:US
Practice Address - Phone:315-492-1964
Practice Address - Fax:315-469-9744
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist