Provider Demographics
NPI:1194057786
Name:DEFREITAS, ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:DEFREITAS
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 1:2307 GREYMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9180
Mailing Address - Country:US
Mailing Address - Phone:518-928-5751
Mailing Address - Fax:
Practice Address - Street 1:3469 ERIE BLVD E
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:NY
Practice Address - Zip Code:13214-1635
Practice Address - Country:US
Practice Address - Phone:315-445-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist