Provider Demographics
NPI:1376726638
Name:GUERESCHI, LORI ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:GUERESCHI
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 1:5399 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2265
Mailing Address - Country:US
Mailing Address - Phone:315-487-6714
Mailing Address - Fax:315-487-0988
Practice Address - Street 1:5399 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2265
Practice Address - Country:US
Practice Address - Phone:315-487-6714
Practice Address - Fax:315-487-0988
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01826306Medicaid