Provider Demographics
NPI:1851575146
Name:FUSILLO, SADIE M (RPH)
Entity Type:Individual
Prefix:MS
First Name:SADIE
Middle Name:M
Last Name:FUSILLO
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 1:3949 ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1111
Mailing Address - Country:US
Mailing Address - Phone:315-622-5405
Mailing Address - Fax:
Practice Address - Street 1:1294 UPPER LENOX AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2681
Practice Address - Country:US
Practice Address - Phone:315-361-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02917935Medicaid