Healthcare Provider Details

I. General information

NPI: 1619191806
Provider Name (Legal Business Name): ST PETERS HOSPITAL OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/14/2017
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: 518-525-1266
  • Fax: 518-525-1917
Mailing address:
  • Phone: 518-525-1266
  • Fax: 518-525-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number000098
License Number StateNY

VIII. Authorized Official

Name: THOMAS LOMBARDI
Title or Position: PHARMACY SYSTEM DIRECTOR
Credential:
Phone: 518-525-1266