Provider Demographics
NPI:1164746863
Name:DURITZO-SPOCINSKI, SHARON
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:DURITZO-SPOCINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 COLONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3451 COLONY DR.
Practice Address - Street 2:
Practice Address - City:BALDWIN HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11510-1151
Practice Address - Country:US
Practice Address - Phone:516-868-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist