Provider Demographics
NPI:1376854125
Name:MYERS, VANESSA NICHOLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICHOLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 COUNTY HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:13315-3502
Mailing Address - Country:US
Mailing Address - Phone:315-858-2589
Mailing Address - Fax:
Practice Address - Street 1:103 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1716
Practice Address - Country:US
Practice Address - Phone:315-717-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist