Healthcare Provider Details

I. General information

NPI: 1275855454
Provider Name (Legal Business Name): ANNE M SHUTOWICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 09/24/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WEIBEL AVE
SARATOGA SPRINGS NY
12866-5328
US

IV. Provider business mailing address

95 WEIBEL AVE
SARATOGA SPRINGS NY
12866-5328
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-0681
  • Fax:
Mailing address:
  • Phone: 518-587-0681
  • Fax: 631-585-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: