Provider Demographics
NPI:1306178975
Name:CARUSO, MARYANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:CARUSO
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 1:350 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2327
Mailing Address - Country:US
Mailing Address - Phone:315-624-9980
Mailing Address - Fax:
Practice Address - Street 1:350 LELAND AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2327
Practice Address - Country:US
Practice Address - Phone:315-624-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist