Provider Demographics
NPI:1467602474
Name:TOMMARELLO, SANDRA J (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:TOMMARELLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2518
Mailing Address - Country:US
Mailing Address - Phone:315-635-3155
Mailing Address - Fax:
Practice Address - Street 1:21 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2501
Practice Address - Country:US
Practice Address - Phone:315-635-3155
Practice Address - Fax:315-635-3734
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI035851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist