Provider Demographics
NPI:1962724070
Name:BEATTIE, SALLY F
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:F
Last Name:BEATTIE
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 1:596 ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159
Mailing Address - Country:US
Mailing Address - Phone:315-696-8796
Mailing Address - Fax:315-696-6145
Practice Address - Street 1:596 ROUTE 11
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159
Practice Address - Country:US
Practice Address - Phone:315-696-8796
Practice Address - Fax:315-696-6145
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist