Provider Demographics
NPI:1104606862
Name:SAADE, ALEXIS LYNN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LYNN
Last Name:SAADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NIAGARA STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201
Mailing Address - Country:US
Mailing Address - Phone:716-242-8608
Mailing Address - Fax:
Practice Address - Street 1:300 NIAGARA STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201
Practice Address - Country:US
Practice Address - Phone:716-242-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-06-17
Deactivation Date:2024-05-22
Deactivation Code:
Reactivation Date:2024-06-14
Provider Licenses
StateLicense IDTaxonomies
NY1070876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist