Provider Demographics
NPI:1760661359
Name:ZUKOSKI, SANDRA BETH (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:BETH
Last Name:ZUKOSKI
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 1:3349 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5513
Mailing Address - Country:US
Mailing Address - Phone:585-383-5650
Mailing Address - Fax:585-381-3156
Practice Address - Street 1:3349 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5513
Practice Address - Country:US
Practice Address - Phone:585-383-5650
Practice Address - Fax:585-381-3156
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist