Provider Demographics
NPI:1134476484
Name:MARCHESON, KATIE LYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:MARCHESON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4772
Mailing Address - Country:US
Mailing Address - Phone:716-515-3290
Mailing Address - Fax:
Practice Address - Street 1:4777 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4772
Practice Address - Country:US
Practice Address - Phone:716-515-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist