Provider Demographics
NPI:1013196583
Name:LOMANTO, KAYOKO (RPH)
Entity Type:Individual
Prefix:
First Name:KAYOKO
Middle Name:
Last Name:LOMANTO
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 1:149 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-3626
Mailing Address - Country:US
Mailing Address - Phone:518-842-8336
Mailing Address - Fax:
Practice Address - Street 1:149 MARKET ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3626
Practice Address - Country:US
Practice Address - Phone:518-842-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist