Provider Demographics
NPI:1265611594
Name:DWAILEEBE, ANITA C (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:C
Last Name:DWAILEEBE
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 1:301 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1617
Mailing Address - Country:US
Mailing Address - Phone:716-372-7443
Mailing Address - Fax:
Practice Address - Street 1:2401 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1921
Practice Address - Country:US
Practice Address - Phone:716-373-1105
Practice Address - Fax:716-373-6297
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042261-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist