Registry details
Type
Individual
Primary specialty
Pharmacist, Ambulatory Care
Enumerated
Mar 1, 2024
License(s)
0202220819 (VA), 071360 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 461 STATE ROUTE 146 APT 5-108 | Guilderland Center, NY 12085-9711 | 518-309-8373 |
| LOCATION | 220 WASHINGTON AVENUE EXT | Albany, NY 12203-5316 | 518-264-4453 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.