Provider Demographics
NPI:1851816995
Name:SANNA, TIERNEY RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:RAE
Last Name:SANNA
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 1:800 WEST MILLER STREET
Mailing Address - Street 2:WEGMANS PHARMACY
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513
Mailing Address - Country:US
Mailing Address - Phone:315-331-7150
Mailing Address - Fax:
Practice Address - Street 1:800 WEST MILLER STREET
Practice Address - Street 2:WEGMANS PHARMACY
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513
Practice Address - Country:US
Practice Address - Phone:315-331-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist