| NPI | 1114062411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICE MCFADDEN Insurance COO Rdinator 518-374-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NY 3300314) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |