Provider Demographics
NPI:1811371610
Name:PHOENIX, DEANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROSWELL PARK CANCER INSTITUTE
Mailing Address - Street 2:ELM AND CARLTON ST, MAIN HOSPITAL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ELM & CARLTON STREETS, MAIN HOSPITAL
Practice Address - Street 2:ROSWELL PARK CANCER INSTITUTE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:716-845-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529271835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052927OtherPHARMACY LICENSE