Healthcare Provider Details

I. General information

NPI: 1619990991
Provider Name (Legal Business Name): GLENS FALLS HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST
GLENS FALLS NY
12801-4447
US

IV. Provider business mailing address

100 PARK ST
GLENS FALLS NY
12801-4447
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-2540
  • Fax: 518-926-2533
Mailing address:
  • Phone: 518-926-2540
  • Fax: 518-926-2533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006069
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL AMADO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 518-926-5113