Provider Demographics
NPI:1104002542
Name:D'ADDARIO, MARY P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:D'ADDARIO
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 1:14 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2197
Mailing Address - Country:US
Mailing Address - Phone:315-464-5172
Mailing Address - Fax:315-464-5171
Practice Address - Street 1:14 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2197
Practice Address - Country:US
Practice Address - Phone:607-753-1591
Practice Address - Fax:607-753-0570
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01403534Medicaid