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NPI Code Detail

MEDICARE: MRS. MARY KATHLEEN LETTKO RPH

MEDICARE: MRS. MARY KATHLEEN LETTKO 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
1183500000XPharmacist038758NY

General Provider Information

NPI Number : 1801061536
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY KATHLEEN LETTKO RPH
Provider Business Mailing Address
First Line : 20 VICTORIAN DR
Second Line :
City : POESTENKILL
State : NY
Zip : 12140-1911
Country : US
Telephone Number : 518-286-2035
Fax Number :
Provider Business Practice Location Address
First Line : 416 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-3007
Country : US
Telephone Number : 518-235-2522
Fax Number : 518-235-2564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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