Provider Demographics
NPI:1912182296
Name:SPERRAZZO, NICHOLE LYNN II
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LYNN
Last Name:SPERRAZZO
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PFOHL PL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6866
Mailing Address - Country:US
Mailing Address - Phone:716-633-0070
Mailing Address - Fax:
Practice Address - Street 1:1625 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-2042
Practice Address - Country:US
Practice Address - Phone:716-894-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist