Healthcare Provider Details

I. General information

NPI: 1689644767
Provider Name (Legal Business Name): EDWARD E. CRETARO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE PHARMACY (119)
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE PHARMACY (119)
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5735
  • Fax:
Mailing address:
  • Phone: 518-626-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number031208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: