Provider Demographics
NPI:1891978631
Name:ZAWADA, COLETTE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:ANN
Last Name:ZAWADA
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 1:121 HERKIMER RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2311
Mailing Address - Country:US
Mailing Address - Phone:315-733-2371
Mailing Address - Fax:315-735-6687
Practice Address - Street 1:121 HERKIMER RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2311
Practice Address - Country:US
Practice Address - Phone:315-733-2371
Practice Address - Fax:315-735-6687
Is Sole Proprietor?:No
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040391-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00572638Medicaid