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General NPI Number Information
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NPI Number | 1366843476
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Entity Type | Organization
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Legal Business Name | PHARMACEUTIC LABS, LLC
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 15 WALKER WAY
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City | ALBANY
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State | NY
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Zip | 12205-4945
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Country | US
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Telephone | 518-608-1060
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Fax | 518-608-6109
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Provider Business Mailing Address
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Address Line | 15 WALKER WAY
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City | ALBANY
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State | NY
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Zip | 12205-4945
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Country | US
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Telephone | 518-608-1060
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Fax | 518-608-6109
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Authorized Official
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Title or Position | PHARMACIST
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Name | SAMANTHA MATTISON
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Credential |
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Telephone | 518-608-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 059848
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License Number State | NY
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