Individual
DR. AMELIA L PERSICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D, RPH
Contact information
Practice address
16 MOXLEY ST, RAVENA, NY 12143-1221
(518) 810-3879
Mailing address
16 MOXLEY ST, RAVENA, NY 12143-1221
(518) 810-3879
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
062961
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
062961
NYS PHARMACY LICENSE
NY
Enumeration date
07/13/2017
Last updated
07/21/2022
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