Provider Demographics
NPI:1669650834
Name:QUINN RISLEY, MARY HELEN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HELEN
Last Name:QUINN RISLEY
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 1:28 PLUM CT
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-3216
Mailing Address - Country:US
Mailing Address - Phone:518-583-1959
Mailing Address - Fax:
Practice Address - Street 1:3031 ROUTE 50
Practice Address - Street 2:T-1271
Practice Address - City:SARATOGA SPGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2926
Practice Address - Country:US
Practice Address - Phone:518-226-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist