Provider Demographics
NPI:1093038804
Name:TESTO, MICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:TESTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 3RD AVE EXT
Mailing Address - Street 2:TARGET PHARMACY T-1796
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-5618
Mailing Address - Country:US
Mailing Address - Phone:518-283-2572
Mailing Address - Fax:518-283-2572
Practice Address - Street 1:625 3RD AVE EXT
Practice Address - Street 2:TARGET PHARMACY T-1796
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-5618
Practice Address - Country:US
Practice Address - Phone:518-283-2572
Practice Address - Fax:518-283-2572
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist