Provider Demographics
NPI:1124392055
Name:FICHTNER, VERONICA ANN (RPH)
Entity Type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:ANN
Last Name:FICHTNER
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 1:355 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2715
Mailing Address - Country:US
Mailing Address - Phone:631-608-2457
Mailing Address - Fax:631-608-2460
Practice Address - Street 1:355 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2715
Practice Address - Country:US
Practice Address - Phone:631-608-2457
Practice Address - Fax:631-608-2460
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist