Provider Demographics
NPI:1447435441
Name:DEACON, MARY CLARE (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CLARE
Last Name:DEACON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2306
Mailing Address - Country:US
Mailing Address - Phone:716-822-9143
Mailing Address - Fax:
Practice Address - Street 1:2025 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1201
Practice Address - Country:US
Practice Address - Phone:716-873-7813
Practice Address - Fax:716-873-2177
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist