Provider Demographics
NPI:1649593823
Name:PICCIONE, PAULA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:PICCIONE
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:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-0018
Mailing Address - Country:US
Mailing Address - Phone:914-923-9200
Mailing Address - Fax:914-923-1111
Practice Address - Street 1:230 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546-1139
Practice Address - Country:US
Practice Address - Phone:914-923-9200
Practice Address - Fax:914-923-1111
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020Medicaid