Provider Demographics
NPI:1407132343
Name:MANCINI, VERONICA ANN (R PH)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:ANN
Last Name:MANCINI
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-0418
Mailing Address - Country:US
Mailing Address - Phone:518-577-8472
Mailing Address - Fax:
Practice Address - Street 1:4192 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6202
Practice Address - Country:US
Practice Address - Phone:518-577-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047412-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist