Provider Demographics
NPI:1518283746
Name:MUELLERLEILE, JOSETTE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JOSETTE
Middle Name:ELIZABETH
Last Name:MUELLERLEILE
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 1:41 MAIN STREET
Mailing Address - Street 2:PHOENICIA PHARMACY
Mailing Address - City:PHOENICIA
Mailing Address - State:NY
Mailing Address - Zip Code:12464
Mailing Address - Country:US
Mailing Address - Phone:845-688-2215
Mailing Address - Fax:845-688-2917
Practice Address - Street 1:41 MAIN ST.
Practice Address - Street 2:PHOENICIA PHARMACY
Practice Address - City:PHOENICIA
Practice Address - State:NY
Practice Address - Zip Code:12464
Practice Address - Country:US
Practice Address - Phone:845-688-2215
Practice Address - Fax:845-688-2917
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist