| NPI | 1376618843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICE R MCFADDEN Insurance Coordinator 518-374-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable (Licence: NY 4601211R) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: NY BC4135580) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2015-03-05 |