Healthcare Provider Details

I. General information

NPI: 1225793151
Provider Name (Legal Business Name): CONNECTRX LATHAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY STE 104
LATHAM NY
12110-2156
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 109
LATHAM NY
12110-2454
US

V. Phone/Fax

Practice location:
  • Phone: 518-313-1016
  • Fax: 518-313-0790
Mailing address:
  • Phone: 518-313-1016
  • Fax: 518-313-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEBRA MARIE HOTALING
Title or Position: DIRECTOR
Credential: R.PH.
Phone: 518-273-1402