Provider Demographics
NPI:1336323708
Name:FIASCHETTI, AMY (BS - PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:FIASCHETTI
Suffix:
Gender:F
Credentials:BS - PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 MAKYES RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-8711
Mailing Address - Country:US
Mailing Address - Phone:315-218-5003
Mailing Address - Fax:
Practice Address - Street 1:3657 W GENESEE ST
Practice Address - Street 2:T-2324
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-2003
Practice Address - Country:US
Practice Address - Phone:315-233-0601
Practice Address - Fax:315-233-0601
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02419730Medicaid