Provider Demographics
NPI:1487836813
Name:PACELLA, KATHLEEN ALICIA (RPH,PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ALICIA
Last Name:PACELLA
Suffix:
Gender:F
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1908
Mailing Address - Country:US
Mailing Address - Phone:716-515-0055
Mailing Address - Fax:716-515-0069
Practice Address - Street 1:2101 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1908
Practice Address - Country:US
Practice Address - Phone:716-515-0055
Practice Address - Fax:716-515-0069
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02842331Medicaid