Provider Demographics
NPI:1134642168
Name:FALICCHIO, ERIN SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:SUE
Last Name:FALICCHIO
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 1:504 SUBURBAN CT APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3834
Mailing Address - Country:US
Mailing Address - Phone:315-751-9492
Mailing Address - Fax:
Practice Address - Street 1:565 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3117
Practice Address - Country:US
Practice Address - Phone:585-244-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY982732OtherNABP