Healthcare Provider Details

I. General information

NPI: 1225021173
Provider Name (Legal Business Name): ANNE M. MYRKA RPH, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 N HOOSICK RD
EAGLE BRIDGE NY
12057-2914
US

IV. Provider business mailing address

64 N HOOSICK RD
EAGLE BRIDGE NY
12057-2914
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-5245
  • Fax:
Mailing address:
  • Phone: 518-686-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number041383
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0330003518
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: