Provider Demographics
NPI:1912226796
Name:PALLOTTA, MICHELE
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:PALLOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:PALLOTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1108 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-2610
Mailing Address - Country:US
Mailing Address - Phone:518-382-1239
Mailing Address - Fax:518-382-7529
Practice Address - Street 1:1108 STATE STREET
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2610
Practice Address - Country:US
Practice Address - Phone:518-382-1239
Practice Address - Fax:518-382-7529
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist