Provider Demographics
NPI:1538482252
Name:BEZIO, KIRSTEN R (RPH)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:R
Last Name:BEZIO
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 1:60 SMITHFIELD BLVD
Mailing Address - Street 2:SUITE 49
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2104
Mailing Address - Country:US
Mailing Address - Phone:518-247-4962
Mailing Address - Fax:518-247-4962
Practice Address - Street 1:60 SMITHFIELD BLVD
Practice Address - Street 2:SUITE 49
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2104
Practice Address - Country:US
Practice Address - Phone:518-247-4962
Practice Address - Fax:518-247-4962
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist