Healthcare Provider Details

I. General information

NPI: 1093047466
Provider Name (Legal Business Name): MAUREEN C HOTALING RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 JUPITER LN
ALBANY NY
12205-6918
US

IV. Provider business mailing address

12 JUPITER LN
ALBANY NY
12205-6918
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-2900
  • Fax: 518-689-2901
Mailing address:
  • Phone: 518-689-2900
  • Fax: 518-689-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: