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General NPI Number Information
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NPI Number | 1851907513
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Entity Type | Organization
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Legal Business Name | WATERVLIET PHARMACY ACQUISITION, LLC
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 601 19TH STREET
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City | WATERVLIET
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State | NY
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Zip | 12189-2002
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Country | US
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Telephone | 518-273-1402
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Fax | 518-687-0672
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Provider Business Mailing Address
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Address Line | 601 19TH ST
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City | WATERVLIET
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State | NY
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Zip | 12189-2002
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Country | US
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Telephone | 518-273-1402
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Fax | 518-687-0672
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBRA MARIE HOTALING
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Credential | R.PH.
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Telephone | 518-273-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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