Individual provider Active NPI

Marisa Tommarello, PHARMD

  • Pharmacist
  • Syracuse, NY
National Provider Identifier
1104545698
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
069429 Issued in NY
Practice address
2515 Erie Blvd E
Syracuse, NY 13224-1109
Phone
(315) 449-2314
NPI assigned
Aug 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 069429 NY Primary

Addresses

Primary practice location

2515 Erie Blvd E
Syracuse, NY 13224-1109

Mailing address

3440 Van Wie Dr E
Baldwinsville, NY 13027-8910
Phone (315) 440-3693

Other practice location 1

3440 Van Wie Dr E
Baldwinsville, NY 13027-8910
Phone (315) 440-3693

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
069429NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1104545698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 VAN WIE DR E",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130278910",
            "telephone_number": "315-440-3693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 ERIE BLVD E",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132241109",
            "telephone_number": "315-449-2314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3440 Van Wie Dr E",
            "address_purpose": "LOCATION",
            "city": "Baldwinsville",
            "state": "NY",
            "postal_code": "130278910",
            "country_code": "US",
            "telephone_number": "315-440-3693",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMMARELLO",
        "first_name": "MARISA",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "069429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.