Provider Demographics
NPI:1396995296
Name:POMYKAJ, MARY BETH (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:POMYKAJ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1267
Mailing Address - Country:US
Mailing Address - Phone:518-828-0050
Mailing Address - Fax:518-828-9279
Practice Address - Street 1:160 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1267
Practice Address - Country:US
Practice Address - Phone:518-828-0050
Practice Address - Fax:518-828-9279
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist