Provider Demographics
NPI:1679859565
Name:HAZEN, JANELLE E (PHARMD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:E
Last Name:HAZEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:BASHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:31 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1845
Mailing Address - Country:US
Mailing Address - Phone:518-495-2807
Mailing Address - Fax:
Practice Address - Street 1:1225 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3317
Practice Address - Country:US
Practice Address - Phone:518-458-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI055714-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist