Basic Information
| Provider Information | |||||||||
| NPI: | 1073845913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GADOMSKI | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 922 SPENCER ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132041137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154921964 | ||||||||
| FaxNumber: | 3154699744 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 SPENCER ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154921964 | ||||||||
| FaxNumber: | 3154699744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 048714 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.