Healthcare Provider Details

I. General information

NPI: 1750007480
Provider Name (Legal Business Name): CARLY JO DIAMOND RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 E MAIN ST
COBLESKILL NY
12043-3803
US

IV. Provider business mailing address

726 EAST MAIN ST CVS HEALTH
COBLESKILL NY
12043
US

V. Phone/Fax

Practice location:
  • Phone: 518-234-8150
  • Fax:
Mailing address:
  • Phone: 518-234-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069182-I
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: