Provider Demographics
NPI:1558699520
Name:SQUILLA, MAUREEN P (RPH)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:SQUILLA
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 1:1198 GERRADS CROSS
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9152
Mailing Address - Country:US
Mailing Address - Phone:585-872-2698
Mailing Address - Fax:
Practice Address - Street 1:789 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2946
Practice Address - Country:US
Practice Address - Phone:585-271-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035520-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist