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General NPI Number Information
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NPI Number | 1487830576
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Entity Type | Individual
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Provider Name | CORINE M BONITATIBUS R.PH.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 1170 WESTERN AVE
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City | ALBANY
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State | NY
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Zip | 12203-3314
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Country | US
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Telephone | 518-459-0795
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Fax | 518-459-0737
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Provider Business Mailing Address
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Address Line | 1170 WESTERN AVE.
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City | ALBANY
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State | NY
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Zip | 12203-3314
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Country | US
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Telephone | 518-459-0795
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Fax | 518-459-0737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 047512
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License Number State | NY
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