Healthcare Provider Details

I. General information

NPI: 1255383782
Provider Name (Legal Business Name): MANDY ROSE TORRES PHARM. D, CGP, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

110 MANNING BLVD
ALBANY NY
12203-1738
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6065
  • Fax: 518-626-6075
Mailing address:
  • Phone: 518-626-6065
  • Fax: 518-626-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number25656
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25656
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: