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General NPI Number Information
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NPI Number | 1134617616
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Entity Type | Organization
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Legal Business Name | THE GOLDEN GALLIPOT APOTHECARY, LLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 472 BROADWAY
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2212
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Country | US
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Telephone | 518-306-5343
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Fax | 518-306-5347
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Provider Business Mailing Address
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Address Line | 472 BROADWAY
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2212
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Country | US
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Telephone | 518-306-5343
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Fax | 518-306-5347
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Authorized Official
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Title or Position | OWNER/SUPERVISING PHARMACIST
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Name | JENNIFER JOYE LAMB
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Credential | PHARM.D
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Telephone | 518-306-5343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 036434
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License Number State | NY
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