Provider Demographics
NPI:1629629449
Name:PELIZZA-TICHENOR, ROMA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROMA
Middle Name:
Last Name:PELIZZA-TICHENOR
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 1:1 GEORGIA LN
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-3405
Mailing Address - Country:US
Mailing Address - Phone:845-661-7940
Mailing Address - Fax:
Practice Address - Street 1:1 GEORGIA LN
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-3405
Practice Address - Country:US
Practice Address - Phone:845-661-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0375111835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric