Provider Demographics
NPI:1013196443
Name:BOMBARD, ANNE L (RPH)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:BOMBARD
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 1:112 NEW YORK RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-3933
Mailing Address - Country:US
Mailing Address - Phone:518-562-3380
Mailing Address - Fax:518-562-9751
Practice Address - Street 1:112 NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-3933
Practice Address - Country:US
Practice Address - Phone:518-562-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038098183500000X
NY038098I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01401885Medicaid