=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386824639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER MICHAEL LAMANNA RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2007
-----------------------------------------------------
Last Update Date | 03/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 HOLLAND AVE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12208-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-426-2976
-----------------------------------------------------
Fax | 518-427-2431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 SUNDEW DR
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12303-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-357-0949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 034804
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------