Provider Demographics
NPI:1518391358
Name:KAM, MARY-CAROLE SANZONE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY-CAROLE
Middle Name:SANZONE
Last Name:KAM
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 1:111 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1722
Mailing Address - Country:US
Mailing Address - Phone:315-443-5691
Mailing Address - Fax:315-443-7981
Practice Address - Street 1:111 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1722
Practice Address - Country:US
Practice Address - Phone:315-443-5691
Practice Address - Fax:315-443-7981
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040388-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist