Provider Demographics
NPI:1669786422
Name:PADOVANO, NICOLE JEANETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEANETTE
Last Name:PADOVANO
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 1:7272 HENRY CLAY BLVD
Mailing Address - Street 2:APT 107
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3580
Mailing Address - Country:US
Mailing Address - Phone:315-727-0550
Mailing Address - Fax:
Practice Address - Street 1:5173 W TAFT RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2656
Practice Address - Country:US
Practice Address - Phone:315-458-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 054866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist