Provider Demographics
NPI:1427537778
Name:DEBBOLI, LAURA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DEBBOLI
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CRANSTON RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7221
Mailing Address - Country:US
Mailing Address - Phone:518-573-2772
Mailing Address - Fax:
Practice Address - Street 1:461 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-1812
Practice Address - Country:US
Practice Address - Phone:518-573-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134312183500000X
NY064266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist