Basic Information
| Provider Information | |||||||||
| NPI: | 1306028592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOZZO | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 4TH AVE | ||||||||
| Address2: | 307 FOURTH AVE | ||||||||
| City: | FRANKFORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133401407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158948302 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 323 E ALBANY ST | ||||||||
| Address2: | 323 EAST ALBANY ST | ||||||||
| City: | HERKIMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133502016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158660274 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 047107 | NY | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 00572665 | 05 | NY | MEDICAID |