=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568786358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA DOLSON PHARMD, RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2010
-----------------------------------------------------
Last Update Date | 03/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 GRANT ST
-----------------------------------------------------
City | WALDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12586-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-414-3993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 EVENING STAR LN
-----------------------------------------------------
City | WALDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12586-2257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-778-8598
-----------------------------------------------------
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 | 050310
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------