=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801307285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARA ARIELLE GARFINKEL PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2017
-----------------------------------------------------
Last Update Date | 10/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 TROY SCHENECTADY RD
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-2493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-782-1360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 COLUMBIA TPKE APT A7
-----------------------------------------------------
City | EAST GREENBUSH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12061-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 063598
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------