Provider Demographics
NPI:1821320995
Name:TOOMAJIAN, EDWARD L
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:TOOMAJIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2002
Mailing Address - Country:US
Mailing Address - Phone:518-273-1402
Mailing Address - Fax:518-687-0672
Practice Address - Street 1:601 19TH ST
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2002
Practice Address - Country:US
Practice Address - Phone:518-273-1402
Practice Address - Fax:518-687-0672
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034300-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist