Provider Demographics
NPI:1205596764
Name:BANASZEK, KYLEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:
Last Name:BANASZEK
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 1:602 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-2234
Mailing Address - Country:US
Mailing Address - Phone:315-446-4820
Mailing Address - Fax:
Practice Address - Street 1:602 NOTTINGHAM RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-2234
Practice Address - Country:US
Practice Address - Phone:315-446-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067616-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist