Healthcare Provider Details

I. General information

NPI: 1629482856
Provider Name (Legal Business Name): SUSAN J CIPPERLEY BS. PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

IV. Provider business mailing address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1616
  • Fax:
Mailing address:
  • Phone: 518-525-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: