Provider Demographics
NPI:1356557821
Name:STANTON, ANDREA SUZANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SUZANNE
Last Name:STANTON
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 1:350 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1116
Mailing Address - Country:US
Mailing Address - Phone:315-761-7979
Mailing Address - Fax:315-361-1197
Practice Address - Street 1:2024 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421
Practice Address - Country:US
Practice Address - Phone:315-361-1184
Practice Address - Fax:315-361-1197
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist