Provider Demographics
NPI:1295953883
Name:BOSTWICK, LAURA J (PHARM D, RPH)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BOSTWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D, RPH
Mailing Address - Street 1:60 WAKEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:617-477-7337
Mailing Address - Fax:
Practice Address - Street 1:315 S. MANNING BLVD
Practice Address - Street 2:INPATIENT PHARMACY ROOM 0621A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-525-8992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2025-09-02
Deactivation Date:2009-10-23
Deactivation Code:
Reactivation Date:2025-08-27
Provider Licenses
StateLicense IDTaxonomies
MA21085183500000X, 1835N1003X
NY067558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support