Provider Demographics
NPI:1851614374
Name:PETRONIO, BECKY B (RPH)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:B
Last Name:PETRONIO
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 1:8378 SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-4956
Mailing Address - Country:US
Mailing Address - Phone:800-627-4455
Mailing Address - Fax:315-624-7982
Practice Address - Street 1:8378 SENECA TURNPIKE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-4956
Practice Address - Country:US
Practice Address - Phone:800-627-4455
Practice Address - Fax:315-624-7982
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037362-11835G0303X
NH21941835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric