Provider Demographics
NPI:1407483860
Name:DELVECCHIO, SARA L
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:DELVECCHIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 W OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5405
Mailing Address - Country:US
Mailing Address - Phone:518-281-2138
Mailing Address - Fax:
Practice Address - Street 1:1057 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1002
Practice Address - Country:US
Practice Address - Phone:518-220-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist