Provider Demographics
NPI:1992000814
Name:ETTIPIO, ANNE (RPH, PHARMD, CGP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:ETTIPIO
Suffix:
Gender:F
Credentials:RPH, PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BROOKFIELD LN
Mailing Address - Street 2:UNIT 5
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1971
Mailing Address - Country:US
Mailing Address - Phone:716-896-5695
Mailing Address - Fax:
Practice Address - Street 1:28 BROOKFIELD LN
Practice Address - Street 2:UNIT 5
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1971
Practice Address - Country:US
Practice Address - Phone:716-896-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0376571835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric