Basic Information
Provider Information
NPI: 1003138876
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ACCHIONE
FirstName: BRET
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3031 VILLAGE BLVD S
Address2:  
City: BALDWINSVILLE
State: NY
PostalCode: 130273603
CountryCode: US
TelephoneNumber: 3159455000
FaxNumber:  
Practice Location
Address1: 437 ELECTRONICS PKWY
Address2:  
City: LIVERPOOL
State: NY
PostalCode: 130886001
CountryCode: US
TelephoneNumber: 3154531750
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/22/2010
LastUpdateDate: 02/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X052679NYY Pharmacy Service ProvidersPharmacist 

No ID Information.


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