Provider Demographics
NPI:1215282603
Name:KRUPA, ALESIA LYNNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALESIA
Middle Name:LYNNE
Last Name:KRUPA
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 1:504 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1470
Mailing Address - Country:US
Mailing Address - Phone:315-736-2302
Mailing Address - Fax:
Practice Address - Street 1:208 HERKIMER RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2314
Practice Address - Country:US
Practice Address - Phone:315-735-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056829-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist