Provider Demographics
NPI:1285919506
Name:MACIOROWSKI, DANIELLE E
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:E
Last Name:MACIOROWSKI
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 1:173 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5726
Mailing Address - Country:US
Mailing Address - Phone:607-423-1069
Mailing Address - Fax:
Practice Address - Street 1:137 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2937
Practice Address - Country:US
Practice Address - Phone:315-343-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011936183500000X
NYI059102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist