Provider Demographics
NPI:1629403860
Name:SCOTTO-LAVINO, DANEEN (RPH)
Entity Type:Individual
Prefix:
First Name:DANEEN
Middle Name:
Last Name:SCOTTO-LAVINO
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 1:677 UPPER GLEN ST
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2014
Mailing Address - Country:US
Mailing Address - Phone:518-798-0622
Mailing Address - Fax:518-798-0623
Practice Address - Street 1:677 UPPER GLEN ST
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2014
Practice Address - Country:US
Practice Address - Phone:518-798-0622
Practice Address - Fax:518-798-0623
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist