Provider Demographics
NPI:1558544015
Name:SCHWARTZ, ALAN B (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9390
Mailing Address - Country:US
Mailing Address - Phone:315-699-9608
Mailing Address - Fax:315-699-1571
Practice Address - Street 1:8379 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9390
Practice Address - Country:US
Practice Address - Phone:315-699-9608
Practice Address - Fax:315-699-1571
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01143113Medicaid