Provider Demographics
NPI:1952582447
Name:VALLONE, MAUREEN HARTIGAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:HARTIGAN
Last Name:VALLONE
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 1:6720 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3344
Mailing Address - Country:US
Mailing Address - Phone:585-223-1460
Mailing Address - Fax:585-223-5139
Practice Address - Street 1:6720 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3344
Practice Address - Country:US
Practice Address - Phone:585-223-1460
Practice Address - Fax:585-223-5139
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00446942Medicaid