Provider Demographics
NPI:1407478357
Name:PELLITTIERI, ALYSSA JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JO
Last Name:PELLITTIERI
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 1:11614 CARY RD
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9555
Mailing Address - Country:US
Mailing Address - Phone:716-512-5588
Mailing Address - Fax:
Practice Address - Street 1:15 EARHART DR STE 101
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-7079
Practice Address - Country:US
Practice Address - Phone:716-929-1000
Practice Address - Fax:716-532-7360
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist