Provider Demographics
NPI:1396068441
Name:IANNONE, KATHLEEN M (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:IANNONE
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 1:2417 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1011
Mailing Address - Country:US
Mailing Address - Phone:585-594-1160
Mailing Address - Fax:
Practice Address - Street 1:150 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3024
Practice Address - Country:US
Practice Address - Phone:585-760-1208
Practice Address - Fax:585-760-1543
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist