Provider Demographics
NPI:1831298603
Name:CARUSO, JILL M (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:CARUSO
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 1:5972 TIPPERARY MNR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9509
Mailing Address - Country:US
Mailing Address - Phone:716-553-3584
Mailing Address - Fax:
Practice Address - Street 1:6606 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6109
Practice Address - Country:US
Practice Address - Phone:716-438-3990
Practice Address - Fax:716-438-3993
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist