MEDICARE: MS. MARY HELEN QUINN RISLEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	039624	NY

General Provider Information

NPI Number	:	1669650834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY HELEN QUINN RISLEY RPH

Provider Business Mailing Address
First Line	:	28 PLUM CT
Second Line	:
City	:	GANSEVOORT
State	:	NY
Zip	:	12831-3216
Country	:	US
Telephone Number	:	518-583-1959
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 ROUTE 50
Second Line	:	T-1271
City	:	SARATOGA SPGS
State	:	NY
Zip	:	12866-2926
Country	:	US
Telephone Number	:	518-226-0578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2008
Last Update Date	:	02/09/2008

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