Provider Demographics
NPI:1508411810
Name:IZZO, MICHAEL RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:IZZO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3666 ST RTE 281
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3576
Mailing Address - Country:US
Mailing Address - Phone:607-753-9359
Mailing Address - Fax:607-758-9569
Practice Address - Street 1:3666 ST RTE 281
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3576
Practice Address - Country:US
Practice Address - Phone:607-753-9359
Practice Address - Fax:607-758-9569
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0656001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist