Provider Demographics
NPI:1356588776
Name:CARDILLO, MARY (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CARDILLO
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 1:5275 SHERIDAN DR
Mailing Address - Street 2:ATTN: PHARMACY MANAGER
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3502
Mailing Address - Country:US
Mailing Address - Phone:716-633-1781
Mailing Address - Fax:716-633-0039
Practice Address - Street 1:5275 SHERIDAN DR
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3502
Practice Address - Country:US
Practice Address - Phone:716-633-1781
Practice Address - Fax:716-633-0039
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041540OtherPHARMACIST LICENSE