Provider Demographics
NPI:1376865212
Name:GOLDEN, MARY H (BS, PHARM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:BS, PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MUSKET MARCH
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3350
Mailing Address - Country:US
Mailing Address - Phone:518-664-8733
Mailing Address - Fax:
Practice Address - Street 1:3 HEMPHILL PL
Practice Address - Street 2:SUITE 116
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4419
Practice Address - Country:US
Practice Address - Phone:518-899-6063
Practice Address - Fax:518-899-6064
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist