Provider Demographics
NPI:1114082294
Name:GIRTLER, RENE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:LYNN
Last Name:GIRTLER
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 1:1070 BEST RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-4101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:549 HOOSICK ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2105
Practice Address - Country:US
Practice Address - Phone:518-274-5080
Practice Address - Fax:518-274-5086
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01394852Medicaid
NY4355050970Medicare ID - Type Unspecified