Provider Demographics
NPI:1679757827
Name:VACCARO, ELIZABETH (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:VACCARO
Suffix:
Gender:F
Credentials:PHARMACIST
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 1589
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0903
Mailing Address - Country:US
Mailing Address - Phone:631-298-5601
Mailing Address - Fax:631-298-3598
Practice Address - Street 1:195 MAIN RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952
Practice Address - Country:US
Practice Address - Phone:631-298-5601
Practice Address - Fax:631-298-3598
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039651-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist