Provider Demographics
NPI:1356665632
Name:GENSLER BAESTLEIN, CYNTHIA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:GENSLER BAESTLEIN
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 1:841 GREENTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5263
Mailing Address - Country:US
Mailing Address - Phone:518-862-2195
Mailing Address - Fax:518-862-2199
Practice Address - Street 1:431 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3868
Practice Address - Country:US
Practice Address - Phone:518-862-2195
Practice Address - Fax:518-862-2199
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist