Provider Demographics
NPI:1750689436
Name:DOLTZ, FREDERICK W (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:W
Last Name:DOLTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4558
Mailing Address - Country:US
Mailing Address - Phone:518-431-9177
Mailing Address - Fax:
Practice Address - Street 1:5 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4558
Practice Address - Country:US
Practice Address - Phone:518-431-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048662183500000X
VT3757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist