Provider Demographics
NPI:1326227844
Name:SANSONE, KENNETH M (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:SANSONE
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 AMERICO CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-3424
Mailing Address - Country:US
Mailing Address - Phone:716-681-3176
Mailing Address - Fax:
Practice Address - Street 1:41 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1648
Practice Address - Country:US
Practice Address - Phone:716-652-5686
Practice Address - Fax:716-652-9421
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01027976Medicaid