Provider Demographics
NPI:1588987408
Name:PESTA, PAMELA A (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:PESTA
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 1:463 SAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2516
Mailing Address - Country:US
Mailing Address - Phone:518-482-2835
Mailing Address - Fax:
Practice Address - Street 1:463 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2516
Practice Address - Country:US
Practice Address - Phone:518-482-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist